Jeoffrey K. Stross

Faculty Tracks and Academic Success

In 1977, the Department of Internal Medicine at the University of Michigan implemented two specific faculty career tracks, the physician-scientist and clinician-scholar, to define more clearly the goals and expectations to which individuals should strive to achieve academic success. In response to the changing environment, a leadership track and a full-time clinical track were added. Although concerns about comparability, transfer between tracks, and research productivity were raised initially, they were alleviated as it became apparent that the ability to achieve tenure was similar in the physician-scientist and clinician-scholar tracks. The development of well-defined faculty tracks has facilitated the alignment of talents, training, and effort with career goals. It has also enabled us to protect the time of young investigators to pursue their research activities and to define the expectations for promotion for clinicians with a major commitment to patient care.

The educationally influential physician

&NA; The existence of physicians who were educationally influential to their peers was confirmed by a series of studies in the 1960s. Methodology to facilitate their identification led to several studies that confirmed their role in the dissemination of information. It was originally thought that the educationally influential physician had its greatest use in continuing medical education. The changes in undergraduate and graduate medical education curriculum now suggest that the educationally influential physician may be operational across the continuum of medical education. The use of small group discussions and reliance on community‐based practitioners demands that the concepts of information dissemination be integrated into curricula for medical students and house officers. Depending on location, specialties, practice type, and learning style, different approaches to information dissemination are possible. As educators strive to incorporate the concepts of evidence‐based medicine and lifelong learning into the curriculum, they need to make students aware of the resources that are available to facilitate their learning.

Effectiveness of Coronary Care Units in Small Community Hospitals

A prospective study was undertaken from 1969 to 1974 to evaluate a program establishing coronary care units in small community hospitals. Crude mortality rates from acute myocardial infarction in these small hospitals were 14.5%, slightly higher but not statistically different from concurrently collected data in three larger comparision hospitals (11.5%). Mutivariate discriminate analysis of clinical characteristics was used to calculate a risk score for each patient admitted. Observed deaths exceeded expected deaths (134 versus 119) (P greater than 0.30) in small hospitals but observed deaths were less than expected (55 versus 77)(P less than 0.05) in comparison hospitals. Mortality was significantly greater in those units admitting fewer than 60 patients with infarctions yearly (20.9%) than in those admitting more than 60 (10.7%) (P less than 0.001). These data suggest that coronary care units in small community hospitals can provide adequate coronary care, but their level of performance drops when fewer than 60 patients with infarctions are admitted yearly.

Information sources and clinical decisions

This study was undertaken to assess the dissemination of information about the management of chronic airway obstruction (CAO) in small community hospitals. The charts of all patients with CAO discharged from six hospitals were audited at two points in time, 1978 and 1983. In addition, physicians were surveyed to determine what information sources were critical in changing their behavior. Significant changes were seen in the use of diagnostic tests and therapeutic agents. Continuing medical education (CME) played a key role in test ordering, while pharmaceutical manufacturers’ representatives were important sources of information concerning new therapeutic agents. The dissemination of information is a complex process. Physicians frequently use multiple sources of information in the decision making process. Physicians and planners of CME must be aware of what types of educational activities are best suited for their needs.

An Epidemic of Mysterious Cardiopulmonary Arrests

Abstract Over a six-week period, a striking increase in the incidence of cardiopulmonary arrests occurred at the Ann Arbor Veterans Administration Hospital. Criminal administration of a muscle-para...

The effects of a cost-education program on hospital charges

An educational intervention designed to change physicians’ use of inpatient services was implemented on two general medical services for a year. The intervention consisted of a brief orientation to cost containment issues, a pamphlet that outlined practical cost containment strategies and listed the charges for commonly ordered tests and services, and access to detailed interim patients’ bills generated during the hospitalization. Two concurrent control services received no intervention. Over 1,600 admissions were evaluated. The geometric mean length of stay was 0.61 days shorter on intervention services compared with control (5.15 vs. 5.76 days, p<0.01). The geometric mean hospital charges were

Personalized targeted mailing increases mammography among long-term noncompliant medicare beneficiaries: A randomized trial

388 less for intervention patients (

House officer interviewing techniques - Impact on data elicitation and patient perceptions

3,199 vs.

The effects of a low-cost intervention program on hospital costs

3,587, p<0.005). Neither patients’ demographic characteristics nor case mix could explain the reductions. The authors conclude that a simple program utilizing information already in existence in most hospitals can result in a significant and meaningful reduction in length of stay and charges.

The human health effects of exposure to polybrominated biphenyls

Objectives.The study purpose was to increase mammography screening among older women by identifying female Medicare beneficiaries without a recent mammogram and assesses the cost-effectiveness of a personalized targeted mailing encouraging them to have a mammogram. Methods.A randomized paired controlled trial included 1229 pairs of women matched on zip code, race, and urban or rural county. Postintervention mammography claims were measured from November 1997 through December 1998. The subjects were female Medicare beneficiaries age ≥ 70, living in Michigan for ≥ 5 years, having no significant comorbidity likely to affect screening, and no mammogram for ≥ 5 years. Intervention subjects received a personally addressed letter from the Medical Director of Michigan Medicare with materials emphasizing the individual’s lack of use of the Medicare mammography screening benefit, reasons for screening, and how to be screened. Results.Women who received the mailing were 60% more likely to have a subsequent mammogram (OR 1.6, P <0.005), with diagnostic mammograms increasing more than screening mammograms (2.8% vs. 0.8%). The absolute increase was greatest for women age 70 to 79, 10.6% in the intervention group versus 6.5% for controls, odds ratio 1.7 (P <0.02). A statewide Medicare intervention in Michigan would cost of