Anderson Spickard

Exogenous lipoid pneumonia

Exogenous lipoid pneumonia is an uncommon condition resulting from aspirating or inhaling fatlike material, such as mineral oil found in laxatives and various aerosolized industrial materials. These substances elicit a foreign body reaction and proliferative fibrosis in the lung. Because symptoms are absent or nonspecific and the roentgenographic findings simulate other diseases, exogenous lipoid pneumonia is often unrecognized. Yet, appropriate historical inquiries and simple laboratory tests can lead to the correct diagnosis, removal of the offending agent, and, potentially, improvement in lung function before serious complications develop.

Physician impairment by substance abuse.

Physician impairment by substance abuse represents a significant challenge to physicians, patients, and society as a whole. Although data is sparse, the prevalence of alcohol and illicit drug abuse among physicians is probably similar to that of the general population, while abuse of prescription drugs may be more prevalent. From a medicolegal standpoint, these issues are managed mostly at the state level and substance abuse is of increasing interest to credentialling organizations such as hospitals and managed care organizations. A variety of concrete steps can be taken to identify physicians with substance abuse problems and treatment approaches have been designed specifically for impaired physicians. With improved attention to the problem of physician impairment by substance abuse, the well-being of both physicians and their patients can be enhanced.

Learning about screening using an online or live lecture: Does it matter?

OBJECTIVE: To determine the impact of an online lecture versus a live lecture on screening given to medical students who are participating in an outpatient clerkship.DESIGN: Prospective, randomized, controlled study.PARTICIPANTS AND SETTING: Ninety-five senior medical students in a primary care medicine clerkship based at university and distant clinic sites.INTERVENTION AND MEASUREMENTS: Forty-eight medical students were randomized to the live lecture on screening (live lecture group), and forty-seven medical students were randomized to the online lecture on screening (online lecture group). Outcome measures included students’ knowledge, use of time, and satisfaction with the lecture experience.RESULTS: Compared to students in the live lecture group, students in the online lecture group demonstrated equal post-intervention knowledge of screening (P=.91) and expended 50 minutes less time to complete the lecture. Online lecture students who used the audio feed of the lecture were equally satisfied with the lecture as the live lecture students. Without the audio feed, online lecture students were less satisfied.CONCLUSIONS: An online lecture on screening is a feasible, efficient, and effective method to teach students on outpatient clerkships about principles of screening.

Teaching evidence-based medicine: Impact on students’ literature use and inpatient clinical documentation

Background: Effective teaching of evidence-based medicine (EBM) to medical students is important for lifelong self-directed learning. Aims: We implemented a brief workshop designed to teach literature searching skills to third-year medical students. We assessed its impact on students’ utilization of EBM resources during their clinical rotation and the quality of EBM integration in inpatient notes. Methods: We developed a physician-led, hands-on workshop to introduce EBM resources to all internal medicine clerks. Pre- and post-workshop measures included students attitudes to EBM, citations of EBM resources in their clinical notes, and quality of the EBM component of the discussion in the note. Computer log analysis recorded students’ online search attempts. Results: After the workshop, students reported improved comfort using EBM and increased utilization of EBM resources. EBM integration into the discussion component of the notes also showed significant improvement. Computer log analysis of students’ searches demonstrated increased utilization of EBM resources following the workshop. Conclusions: We describe the successful implementation of a workshop designed to teach third-year medical students how to perform an efficient EBM literature search. We demonstrated improvements in students’ confidence regarding EBM, increased utilization of EBM resources, and improved integration of EBM into inpatient notes.

A randomised trial of an online lecture with and without audio.

Objective  To determine the impact of adding audio‐feed to an online lecture on screening given to medical students who were participating in an outpatient clerkship.

The Computer-based Lecture

Advancing computer technology, cost-containment pressures, and desire to make innovative improvements in medical education argue for moving learning resources to the computer. A reasonable target for such a strategy is the traditional clinical lecture. The purpose of the lecture, the advantages and disadvantages of “live” versus computer-based lectures, and the technical options in computerizing the lecture deserve attention in developing a cost-effective, complementary learning strategy that preserves the teacher-learner relationship. Based on a literature review of the traditional clinical lecture, we build on the strengths of the lecture format and discuss strategies for converting the lecture to a computer-based learning presentation.

Proposed Standards for Medical Education Submissions to the Journal of General Internal Medicine

To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects’ protection and ethical research conduct. Additional standards for specific study types are described. We hope these proposed standards will generate discussion that will foster their continued evolution.

Automatic Capture of Student Notes to Augment Mentor Feedback and Student Performance on Patient Write-Ups

ObjectiveTo determine whether the integration of an automated electronic clinical portfolio into clinical clerkships can improve the quality of feedback given to students on their patient write-ups and the quality of students’ write-ups.DesignThe authors conducted a single-blinded, randomized controlled study of an electronic clinical portfolio that automatically collects all students’ clinical notes and notifies their teachers (attending and resident physicians) via e-mail. Third-year medical students were randomized to use the electronic portfolio or traditional paper means. Teachers in the portfolio group provided feedback directly on the student’s write-up using a web-based application. Teachers in the control group provided feedback directly on the student’s write-up by writing in the margins of the paper. Outcomes were teacher and student assessment of the frequency and quality of feedback on write-ups, expert assessment of the quality of student write-ups at the end of the clerkship, and participant assessment of the value of the electronic portfolio system.ResultsTeachers reported giving more frequent and detailed feedback using the portfolio system (p = 0.01). Seventy percent of students who used the portfolio system, versus 39% of students in the control group (p = 0.001), reported receiving feedback on more than half of their write-ups. Write-ups of portfolio students were rated of similar quality to write-ups of control students. Teachers and students agreed that the system was a valuable teaching tool and easy to use.ConclusionsAn electronic clinical portfolio that automatically collects students’ clinical notes is associated with improved teacher feedback on write-ups and similar quality of write-ups.

Outpatient morning report: A New Conference for Internal Medicine Residency Programs

To clarify the use of outpatient morning report in internal medicine residency programs, we conducted a national survey of internal medicine residency directors and a local survey of a cohort of residents at a large teaching hospital. The program directors reported a 24% prevalence of outpatient morning report. The cohort of residents reported that the conference contributed much to their education by meeting specific learning needs and covering topics not covered elsewhere in their residency training.

Sexual Boundaries and Physicians: Overview and Educational Approach to the Problem

The extent of physician/patient sexual involvement is difficult to determine. Other types of sexual boundary violations involving physicians are equally difficult to determine. Reports of incidents of sexual involvement between physician and patient range in the 3- to-10 percent range. The range of severity and the complexity of sexual misconduct make simple solutions impossible. It is imperative that physician health programs and state medical boards develop individualized responses to this problem. In some situations, following an in-depth assessment, an educational program may be appropriate.