Beverly Woo

Residency Training in Primary Care Internal Medicine: Report of an Operational Program

The Primary Care Program at the Massachusetts General Hospital is designed to develop competence in the full range of problems encountered by general internists delivering primary care. House staff spend 3 years in the program, which starts with internship, includes a senior residency, and fulfills the requirements for board eligibility in internal medicine. Half of the training is provided in outpatient care settings. House staff assume responsibility for organization and operation of an ambulatory medical unit. In addition, there is supervised instruction in office gynecology, orthopedics, ear, nose and throat, dermatology, and psychiatry. Close integration with the traditional inpatient-oriented training program is maintained to ensure commensurate growth and competence in management of acute, life-threatening disease.

Randomised trial of early clinical training for students

observing the various sequential steps, and scrutinising the technical details, such as tying a surgical knot. What was done Following suggestions to make a more visually oriented didactic curriculum, we developed a 12-chapter instructional DVD on wound closure. These chapters cover the following basic and advanced concepts: equipment; anaesthesia; irrigation; starting the procedure; simple interrupted sutures; horizontal mattress; vertical mattress; corner sutures; buried sutures; tissue adhesives; steristrips, and staples. These instructional modules incorporate digital videos of actual patients and animal models undergoing wound repair, instructional voiceover, cross-sectional diagrams, and animation. Software used included Quicktime Pro, iMovie, Photoshop, Macromedia Flash MX, and Swift 3D Animation. Evaluation of results and impact Preliminary results from a prospective, randomised study of 46 preclinical medical students, comparing a traditional lecture to our instructional DVD, demonstrated that the DVD is superior. Those in the DVD study arm recorded higher competency test scores and reported a greater comfort level with wound closure. Further the students preferred the DVD teaching approach, because the DVD allowed for them to view chapters at their own time and pace. Chapters could be re-viewed to clarify confusing concepts, prior to attending the practical workshop. Consequently, these instructional chapters have been incorporated into the required course Preparation for Clerkships for all medical students at our institution who are starting their clinical rotations. Despite having these modules replace the traditional ‘live’ lecture prior to the animal model workshop, overwhelmingly positive comments make this DVD extremely promising as a resource in the global medical community of medical students, nurse practitioners and doctor assistants. This instructional DVD is a potential solution to variable wound closure education and training.