Mitchell Charap

The Periodic Health Examination: Genesis of a Myth

Although the periodic health examination was introduced over 80 years ago, it remains a controversy in internal medicine. There have been few data from controlled studies to document the examinations efficacy for adults; nevertheless, its popularity is increasing and health screening has become a multimillion-dollar industry in the United States. Conclusions drawn from poorly designed studies 65 years ago led to the acceptance of periodic examination as a means of detecting disease and reducing mortality. First, physicians associated with life insurance companies and, later, private practitioners began offering these examinations. By promoting the periodic health examination, the medical profession created interest among the general population. The impact of health screening is still unknown today, and well-designed studies are needed to resolve the controversy.

Physician choices in the treatment of angina pectoris

Uncertainty about optimal treatment for many diseases results in heterogeneous management by definition. It was hypothesized that identifiable characteristics in a physicians background would influence the management of any such condition and thereby explain some of this heterogeneity. A vignette describing a patient with new-onset angina and a questionnaire ascertaining individual physician characteristics and management preferences were sent to attending physicians and house staff in the Department of Medicine at New York University School of Medicine. Although physicians believed very strongly that the patient had angina on the basis of the history, there was no consensus about managing the hypothetic patient. The age of the physician was the single most important predictor of management, with the younger half of the sample more likely to hospitalize (p less than 0.001), less likely to prescribe nitroglycerin as a sole therapy (p less than 0.005), and more likely to prescribe beta blockers (p less than 0.005). The era in which a physician trains may determine practices that persist for a lifetime. These findings may have important implications for medical education and the quality and cost of medical care.

Development of a hospitalist-led-and-directed physical examination curriculum

BACKGROUND Deficiencies in physical examination skills among medical students, housestaff, and even faculty have been reported for decades, though specifics on how to address this deficit are lacking. METHODS Our institution has made a commitment to improving key physical examination competencies across our general medicine faculty. Development of the Merrin Bedside Teaching Program was guided by a comprehensive needs assessment and based on a learner-centered educational model. First, selected faculty fellows achieve expertise through mentorship with a master clinician. They then develop a bedside teaching curriculum in the selected domain and conclude by delivering the curriculum to peer faculty. RESULTS We have developed curricula in examination of the heart, shoulder, knee, and skin. Currently, curricula are being developed in the examination of the lungs, critical care bedside rounds, and motivational interviewing. Curricula are integrated with educational activities of the internal medicine residency and medical school whenever possible. CONCLUSIONS A hospitalist-led physical examination curriculum is an innovative way to address deficits in physical exam skills at all levels of training, engenders enthusiasm for skills development from faculty and learners, offers scholarship opportunities to general medicine faculty, encourages collaboration within and between institutions, and augments the education of residents and medical students.

National Resident Matching Plan

Excerpt To the Editor:The analysis of National Resident Matching Plan data (1) obfuscates rather than illuminates the data. The major problems are the division of networks into importing, exporting...