Frank T. Stritter

Can Residents Be Trained to Counsel Patients about Quitting Smoking? Results from a Randomized Trial

Study objective:To evaluate the effectiveness of two teaching interventions to increase residents’ performance of smoking cessation counseling.Design:Randomized controlled factorial trial.Setting:Eleven residency programs, in internal medicine (six), family medicine (three), and pediatrics (two). Programs were located in three university medical centers and four university-affiliated community hospitals.Participants:261 residents who saw ambulatory care patients at least one half-day per week, and 937 returning patients aged 17 to 75 years who reported having smoked five or more cigarettes in the preceding seven days. Of the 937, 843 were eligible for follow-up, and 659 (78%) were interviewed by phone at six months.Interventions:Two interventions (tutorial and prompt) and four groups. The tutorial was a two-hour educational program in minimal-contact smoking cessation counseling for residents. The prompt was a chart-based reminder to assist physician counseling. One group of residents received the tutorial; one, the prompt; and one, both. A fourth group received no intervention.Measurement and results:Six months after the intervention, physician self-reports showed that residents in the tutorial + prompt and tutorial-only groups had used more counseling techniques (1.5–1.9) than had prompt-only or control residents (0.9). Residents in all three intervention groups advised more patients to quit smoking (76–79%) than did control group residents (69%). The tutorial had more effect on counseling practices than did the prompt. Physician confidence, perceived preparedness, and perceived success followed similar patterns. Exit interviews with 937 patients corroborated physician self-reports of counseling practices. Six months later, self-reported and biochemically verified patient quitting rates for residents in the three intervention groups (self-reported: 5.3–8.2%; biochemically verified: 3.4–5.7%) were higher than those for residents in the control group (self-reported: 5.2%; biochemically verified: 1.7%), though the differences were not statistically significant.Conclusion:A simple and feasible educational intervention can increase residents’ smoking cessation counseling.

Education in Ambulatory Settings: Developing Valid Measures of Educational Outcomes, and Other Research Priorities.

Efforts to redesign education in ambulatory settings are hampered by a lack of rigorous and coherent research on the learning process in these settings and the desired outcomes of the educational experiences. The authors present 13 priority research topics and 51 important research questions concerning education in ambulatory settings that were defined by a distinguished group of medical educators, clinicians, and policymakers who attended an invitational conference on education in ambulatory settings in 1996. The need to establish valid and reliable measures of quality and outcomes of educational programs and instructional interventions stood out as the major prerequisite for conducting research on education in ambulatory settings. Issues of theory building, research priorities, and research design are discussed, and policy recommendations are made for the development of valid measures of educational outcomes. The creation of a “Medical Education Outcomes Commission” is proposed to act as a repository for measures and instruments, and to provide the field with mechanism to validate instruments and uniform recommendations to conduct studies of quality. The authors urge funding agencies with missions that support medical education to invest in basic research on the outcomes of education in ambulatory settings.

Faculty development in the health professions: Conclusions and recommendations

This report summarizes recent literature reviews and resource books on faculty development in the health professions and describes findings from articles not previously reviewed. Nine conclusions about faculty development in the health professions are drawn: (1) the concept of faculty development is evolving and expanding; (2) research skills are becoming a major focus of faculty development; (3) teaching skills are still a prominent aspect of faculty development; (4) fellowships are being used effectively to recruit and train new faculty; (5) the institutional environment has become a focus of faculty development; (6) faculty evaluation is an effective approach to faculty development; (7) the efficacy of faculty development needs better research documentation; (8) model curricula have been developed for different types of faculty; and (9) comprehensive faculty development centers are gaining in popularity. A set of recommendations based on the conclusions drawn is offered for those planning faculty development interventions.

An analysis of learning experiences contributing to medical students’ self‐efficacy in conducting patient education for health promotion

Changes in health care needs suggest that medical students should learn health‐promotion skills to better help their patients. The purpose of this study was to examine medical students’ experiences in learning to educate patients about smoking cessation, nutrition, and exercise and how those experiences contribute to students’ self‐efficacy in educating patients. Using a qualitative case‐study approach, data were obtained through student and faculty interviews, document review, and a questionnaire to measure students’ self‐efficacy. Although overall learning opportunities were limited, students’ perceptions of self‐efficacy were high. Three patterns of experience were evident that were associated with differences in student interests and beliefs, opportunities to practice patient education, presence of faculty role models, and complexity of patient‐education strategies learned. Self‐efficacy levels varied across the patterns of experience. The results suggest the importance of specific educational practic...

Faculty development fellowship programs in family medicine

A new format for training medical school faculty members was begun in 1978 when the federal government and the Robert Wood Johnson Foundation simultaneously began funding separate faculty development programs for family medicine faculty members. The goals of these two programs were to recruit and prepare new physician faculty members for family medicine educational programs. In the present study, the authors assessed the impact of these programs by a review of grant proposals and a survey of alumni for each program. They found that very different fellowship programs developed under these two funding sources. Consequently, the two programs produced participants who went to different academic settings and became involved in quite different activities, especially in the area of scholarly work. However, regardless of the program the participants chose, common factors were found to characterize those who were active in scholarly areas and those who were less active. Based on these findings, recommendations are offered to future planners and funders of faculty development programs for preparing new physician faculty members.

Determining essential faculty competencies

This study identified nonclinical competencies needed by faculty members in family medicine to fulfill their academic responsibilities. The competencies that were identified served as one of the bases for development of a model curriculum in faculty development. Names of 452 “exemplar”; faculty members were obtained from departments of medical education in schools of medicine, departments of family medicine, and residency programs in family medicine. Exemplar faculty were considered highly able to identify competencies critical for their success and applicable to other faculty. A questionnaire was mailed to all those identified, with 61% responding. Analyses were undertaken, comparisons were made, and conclusions were drawn. The overall conclusions is that competencies have been identified that describe generic essential faculty abilities, and these can serve as an important basis for development of the model curriculum.

The Delphi technique in curriculum development

The faculty of a state supported medical school recently approved the addition of a 1‐month clerkship in ambulatory care to the fourth year of its MD curriculum. The committee designing the clerkship used the Delphi technique in obtaining a variety of opinions from a panel of experts to form a consensus regarding the new programs curriculum components. The three‐iteration technique was completed in 6 months and provided information that facilitated the development of a proposal for the design of the new clerkship. The proposal included the following: priority health issues to be addressed by the clerkship, necessary attributes of training sites and preceptors, instructional goals, recommended instructional approaches, methods for evaluation of student performance, and methods for program and site evaluation. This article describes the use of the Delphi technique in developing the consensus.

The shift to primary care: emerging influences on specialty choice.

No abstract available.

Systematic survey of opinion regarding the thoracic surgery residency

To summarize this rather wide-ranging study, let us review the high points. The future practice of thoracic surgery will be increasingly affected by governmental factors and will have even greater technological dimensions. To do this work, we must continue to attract high-caliber individuals, and this is best accomplished by the early and continuing involvement in the educational process of strong role models from our field. These future surgeons must be motivated to do good work and should have high ethical standards as well as maturity and high intelligence. Experienced, involved faculty leading the residents through a broad program that offers graduated assumption of clinical and leadership responsibilities will facilitate the development of mature clinical judgment. Residents must be taught the clinical skills necessary to do all thoracic operations, leaving subspecialization to postresidency fellowships. The educational program should be humane in its demands and collegial in its application. It should incorporate experiences beyond the operating room, including the opportunity to read, think, and interact with local mentors and colleagues from around the country. The requirements of certification should not be so rigid as to preclude the development of different pathways to the same end. Likewise, although the accreditation process must protect the resident from exploitation, it must not be so restrictive that it does not allow for educational innovation and justifiable differences among programs. These are the thoughtful opinions of our colleagues. They deserve serious consideration.

The teaching scholars program: Promoting teaching as scholarship

In this article, we describe an attempt at one school of medicine to develop and implement a program intended to increase the status of teaching as a faculty responsibility. The Teaching Scholars Program (TSP) enrolls 10 to 12 faculty members in a 2‐year curriculum of seminars, practica, and a research project in which the participants learn to appreciate the scholarship of instruction. Favorable reactions have been noted to date, and TSP graduates are assuming positions of educational leadership in the school.