John V. Fulginiti

Characteristics influencing career decisions of academic and nonacademic emergency physicians.

STUDY OBJECTIVE To determine characteristics motivating physicians to choose careers in academic and nonacademic emergency medicine. DESIGN A written survey of 1,017 active members of the Society for Academic Emergency medicine and of a random sample of 2,000 members of the American College of Emergency Physicians was performed. Questions were asked regarding medical school, residency, and fellowship training; the importance of specific factors in influencing career decisions; and perceived obstacles to emergency medicine research. Responses from nonfaculty and adjunct, clinical, and research faculty were compared using chi 2 analysis for discrete variables and a four-group analysis of variance for continuous variables. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Responses were obtained from 1,203 physicians (41.3%). Those choosing academic careers were significantly more likely to complete a residency in emergency medicine or internal medicine and fellowship training in research or toxicology compared with nonacademic physicians. Nonfaculty and clinical faculty considered family obligations, leisure time, and personal income to be the most important factors influencing their career decisions; research faculty considered role models and the value of research to be most important. There was no difference in indebtedness among the groups. Finding time and funding, administrative obligations, and pressures to do clinical work were the most important obstacles to research productivity. CONCLUSION Factors influencing career decisions can be used to plan strategies to meet the future needs of academic emergency medicine.

Educating Generalist Physicians about Chronic Pain: Live Experts and Online Education Can Provide Durable Benefits

OBJECTIVE Determine whether lectures by national experts and a publicly available online program with similar educational objectives can improve knowledge, attitudes, and beliefs (KAB) important to chronic pain management. DESIGN A pretest-posttest randomized design with two active educational interventions in two different physician groups and a third physician group that received live education on a different topic to control for outside influences, including retesting effects, on our evaluation. PARTICIPANTS A total of 136 community-based primary care physicians met eligibility criteria. All physicians attended the educational program to which they were assigned. Ninety-five physicians (70%) provided complete data for evaluation. MEASUREMENTS Physician responses to a standardized 50-item pain management KAB survey before, immediately after, and 3 months following the interventions. RESULTS The study groups and the 41 physicians not providing outcomes information were similar with respect to age, sex, race, percent engaged in primary care, and number of patients seen per week. Physician survey scores improved immediately following both pain education programs (live: 138.0-->150.6, P < 0.001; online: 143.6-->150.4, P = 0.007), but did not change appreciably in the control group (139.2-->142.5, P > 0.05). Findings persisted at 3 months. Satisfaction measures were high (4.00-4.72 on 1-5 scale) and not significantly different (P = 0.072-0.893) between groups. CONCLUSIONS When used under similar conditions, national speakers and a publicly available online CME program were associated with improved pain management KAB in physicians. The benefits lasted for 3 months. These findings support the continued use of these pain education strategies.

Factors influencing radiologists to choose research careers.

The future of radiology is threatened by the paucity of competent researchers who are radiologists. To determine what influences are most important in selecting and training potential radiology researchers, we conducted a survey of 5000 practicing radiologists, including all members of the Association of University Radiologists. We also surveyed 3000 randomly selected radiology trainees. A research career was empirically defined as 20% or more of a radiologists time being involved with research. Response to the practicing radiologists and radiology trainees surveys was 28% and 19%, respectively. Radiologists who attended medical school or trained in radiology at an institution among the top 20 for research funding more frequently chose careers in research than those who matriculated and trained elsewhere. Publishing at least one research article, having a dedicated radiology research fellowship, having access to grant funds, and using computers during medical school or radiology training were factors typifying radiologists who chose research careers. Research radiologists were more concerned about the value of performing research and less concerned about personal income than those choosing careers not focusing on research. These results suggest that it might be possible to select radiology trainees who are more likely to become researchers based on their backgrounds and attitudes. An appropriate milieu during training enhances the likelihood of radiologists choosing research careers.

Factors influencing resident career choices in emergency medicine

OBJECTIVE To assess the attitudes of residents in emergency medicine regarding a career in academics. DESIGN A 22-item questionnaire was administered to residents in conjunction with the yearly American Board of Emergency Medicine inservice examination. Demographic information and factors influencing career intent were elicited. Respondents were classified by intent on a career in emergency medicine. A three-way analysis of variance was used to address group differences for eight specific factors impacting on career decision. Chi-square analysis was used to address questions involving relationships among variables with dichotomous or categorical responses. RESULTS The survey was distributed to 1,654 residents, and 1,238 (75%) completed the questionnaire. Motivating factors demonstrating significant differences between those residents planning an academic career and those not interested in academe were a desire to do research, desire to teach, desire to make a contribution to medicine, and exposure to role models, with less emphasis on the need for free time for other interests and less concern regarding practice location. More than 80% of those not going into academic emergency medicine believed they were adequately exposed to research in residency compared with 65% of those intent on a career in academe (P less than .01). Research in medical school, residency, and authorship of a research paper were significantly more prevalent for those residents desiring a career in academe (P less than .01). Twenty-six percent of residents responded that their role models for research were less than adequate. Seventeen percent of residents intend to take fellowship training. The most popular fields for fellowships were toxicology (25%), emergency medical services (21%), pediatrics (15%), and research (9%). CONCLUSION The results of this survey address attitudes among residents toward a career in academic emergency medicine. Factors such as motivation, role models, and exposure to research may help academicians plan strategies to meet the future needs of academic emergency medicine.

Teaching and evaluation of physical examination skills on the surgical clerkship

It is presumed that graduating medical students possess adequate physical examination skills, although they are rarely evaluated during the clinical years. In this study we assessed the physical examination skills of third‐year medical students at the beginning and end of a surgical clerkship and investigated the effect of clerkship experiences and formal feedback on maturation of these skills. Sixty‐seven third‐year students completed a course on physical examination during their second year of medical school and achieved a 90% performance level on a physical examination performed on a patient instructor. This group subsequently performed a focused physical examination (chest, abdomen, groin [hernia], and external genitalia) during Week 1 and Week 6 of a 6‐week third‐year surgical clerkship. The physical examination was observed and evaluated using a 38‐item checklist; feedback was provided immediately after the first examination. Pretest performance was significantly poorer than that achieved in the sec...

Research and research training in academic radiology departments. A survey of department chairmen.

We surveyed 121 chairmen of academic radiology departments to assess how these departments select and educate their residents and fellows in research. Eighty-six chairmen responded (71%). The majority of their programs select at least some of their trainees for their potential as researchers and nearly all encourage trainees to perform research. The more the selection process focuses on research, the greater the percentage of residents and fellows that participate in research during training. Nonetheless, only about one-third of residents and half of the fellows perform and publish research. Only half the programs offer formal research seminars and few trainees opt for additional research training. These results may relate to the relatively small percentage of faculty performing prospective clinical and laboratory research. These findings are disappointing in the light of previous results suggesting that performing research, publication, and formal research education during training correlate highly with the development of successful research careers. Chairmen could increase the likelihood of trainees choosing research careers and being successful in publishing research by providing early exposure to research experiences and providing formalized research training.

Structured single-observer methods of evaluation for the assessment of ward performance on the surgical clerkship

This study compares the traditional method (TM) of evaluating ward performance on the surgical clerkship with four structured, single-observer methods (SSOM) of evaluating the clinical skills demonstrated in patient workups, progress notes, physical examination, and technical performance. SSOM differed from TM in preciseness of evaluation criteria, training of evaluator, and amount of direct observation of clinical performance. SSOM appeared to be a more precise measurement instrument than TM and far more sensitive to the detection of clinical improvement. The study documents the significant contribution of a nurse-educator to the evaluation process, as this contribution correlates well with TM yet provides a unique and independent perspective. Finally, SSOM of evaluation correlated significantly with oral examination and the National Board of Medical Examiners (NBME) test results. Addition of SSOM to TM is recommended for clerkship evaluation of ward performance.

Structural Equation Modeling in Clinical Assessment Research with Children.

The use of structural equation modeling has gained increased interest in recent years in the social and behavioral sciences. This article reviews the basic tenets of structural modeling in relation to issues in research and practice involving clinical assessment and compares this approach with more traditional psychometric approaches to the validation of assessment instruments with children. Arguments for and against the inclusion of nonexperimental variables in causal studies aimed at establishing construct validity are also discussed. An illustrative example of the application of structural equation modeling in clinical assessment research is provided, and a comparison is made between this approach and traditional psychometric procedures. Implications and suggestions for the use of structural modeling are discussed for both the practitioner and the clinical researcher.

A model for the assessment of students' physician-patient interaction skills on the surgical clerkship☆

Physician-patient interaction skills are predominantly taught by successful role modeling but are rarely evaluated formally and systematically. This study describes a new model for the assessment of student physician-patient interaction skills and reports results of use in 78 third-year medical students on clerkships at two institutions. A single nurse instructor at each institution evaluated these skills using an 18-item checklist during student performance of wound care and dressing changes. Students were focused on the evaluation of their technical skills and were unaware of the evaluation of their interaction skills. Immediate feedback on performance was provided. The mean percentage score for the interaction skills was 35%, and no improvement was noted with greater clinical experience (later rotations). We conclude that there is a striking deficiency in physician-patient interaction skills among third-year students. The model described is effective for both evaluation and feedback.

Scores on Standard Measures of Academic Achievement and Family Practice Clerkship Evaluations by Students Choosing Family Practice and Non-Family Practice Specialties.

Six hundred fifty‐eight students graduating from the University of Arizona between 1983 and 1990 were included in an analysis of specialty selection (family practice vs. non‐family practice) and academic achievement as measured by undergraduate science and nonscience grade point averages, Medical College Admissions Test scores, National Board of Medical Examiners (NBME) Part I and Part II scores, and family practice clerkship evaluations. Students choosing family practice scored lower on NBME Parts I and II than students who did not choose family practice. These differences were stable over time. However, there were no differences in scores among students choosing family practice, pediatrics, and internal medicine. Students choosing family practice and non‐family practice specialties did not differ on scores received in the family practice clerkship evaluations.