Rebekah Wang-Cheng

Bedside Case Presentations: Why Patients Like Them but Learners Don't.

Study objective:To determine current attitudes of patients, medical students, housestaff, and clinical faculty toward bedside case presentations.Design:Survey using multiple-choice questionnaire and open comments for students, housestaff, and faculty, and a structured interview of patients.Setting:Major teaching hospitals on the campus of a mid-western medical school, staffed by full-time faculty.Participants:136 medical students, 58 housestaff, 66 faculty, and 73 patients.Measurements and main results:85% of patients liked the case presentation discussion at the bedside, but 95% of both students and housestaff felt more comfortable with such discussion away from the patient. Attending faculty were about evenly divided in preference, with the younger staff preferring the conference room setting. Most patients (88%) opposed rounds in the ballway. Duration of rounds of one to two hours was felt desirable by most, but 50% of students preferred a duration of less than one hour. For length of new patient case presentation, 60% of learners again favored brevity, less than 5 minutes.Conclusions:Bedside rounds are an opportunity to sharpen diagnostic skills and to demonstrate the art of medicine. They are undervalued by learners and younger faculty but appreciated by patients. The authors recommend that faculty improve bedside rounds by assessing team members’ educational needs, by cultivating sensitivity and respect for the needs of all parties, and by assuring pertinence and brevity of bedside discussion.

Psychiatric Side Effects of Steroid Therapy

Many psychiatric side effects have been noted with steroid administration. Occurring in about 6% of all patients on steroids, they are not uncommon. The English-language literature from 1951 to the present reveals numerous case reports and reviews but few prospective, controlled studies exploring this issue. This paper reviews the various psychiatric presentations and the relationship to patient profile, steroid type, dosage, and therapy duration. In 90% of cases, symptoms are reversible with steroid termination; some patients require psychopharmacologic treatment. Prophylaxis with lithium carbonate has met with good response in a few anecdotal reports and one prospective study.

Effect of student and preceptor gender on clinical grades in an ambulatory care clerkship.

BACKGROUND. Although several studies have addressed the effect of student gender on clinical performance evaluation, none has looked at the effect of preceptor gender or the interaction of preceptor gender and student gender. We investigated the possibility of gender effects in an ambulatory care clerkship where the preceptor-student ratio is usually one to one. METHOD. Clinical grades given by preceptors to third-year students after a required one-month ambulatory care medicine clerkship were analyzed by student gender, preceptor gender, and preceptor-student gender pairs. The study was conducted from August 1990 to October 1992 at the Medical College of Wisconsin. A total of 121 preceptors (97 men and 24 women) and 375 students (233 men and 142 women) participated. Analyses of variance were used to detect significant differences. RESULTS. On a scale of 0 to 4, the female students received a higher mean clinical grade than the male students (3.1 versus 3.0, p < .04). Preceptor gender had no effect on clinical grades until student gender was considered. The highest mean grade of 3.3 was given by male preceptors to female students, and the lowest mean grade of 2.9 was given by female preceptors to male students (p < .01). CONCLUSION. The female students received higher clinical grades in the ambulatory care clerkship, especially when the preceptor was male. Perhaps gender interaction should be considered when assigning students to preceptors and evaluating grading practices.

Impact of aging on preoperative evaluation

Approximately 40% of physician office time and 33% of hospital time are devoted to patients 65 years of age or older. Over half of the older population requires some surgical intervention. Because of decreased physiologic reserve and increased number of underlying medical disorders, the older patient is at increased risk for intraoperative and postsurgical complications. Since cardiovascular, pulmonary, and renal complications are frequent in the elderly patient, the preoperative evaluation should emphasize these organ systems. Risk factors should be assessed initially by a focused history and physical examination and by simple tests. Additional diagnostic testing should be reserved for the patient who is not clearly at low or high risk. For optimal preoperative evaluation of the elderly patient, the physician should identify systemic disease, determine if the patient is receiving appropriate therapy, delineate the operative risks, and make recommendations that can potentially reduce the operative risks and postoperative complications.

Postmenopausal hormone therapy: a concise guide to therapeutic uses, formulations, risks, and alternatives.

Postmenopausal hormone replacement therapy is helpful in relieving menopausal vasomotor symptoms and vaginal atrophy and can prevent osteoporosis; however, attendant risks include breast cancer, thromboembolism, gallbladder disease, stroke, CHD, dementia, and hypertriglyceridemia. Decision making must weigh these risks and benefits and also include potential benefits on mood, colorectal cancer prevention, and hip fracture reduction. Some areas, such as ovarian cancer risk and the impact of combination estrogen-progestin versus unopposed estrogen on risk, remain unclear. The physician and patient need to carefully assess, discuss, and monitor the individuals symptoms and risks when considering HT use. For those with contraindications or concerns about HT, there are alternative therapies of variable efficacy for vasomotor symptoms and vaginal atrophy.

The third report of the US Preventive Services Task Force

New guidelines are timely, accessible, and useful in primary care

Both sides now: a leap from academics to solo practice

From BMJ USA 2003;April:208 Posted on the outside of my office door were two of my favorite quotes: George Bernard Shaws “I want to be thoroughly used up when I die. Life is no brief shining candle to me, but a brightly lit torch that I want to burn as brightly as possible before handing it on to the next generation,” and “Education is not the filling of a pail but the lighting of a fire” by William Butler Yeats. Teaching students and residents was indeed the “fire in my belly,” my calling and passion for 19 years, after I stumbled into an academic career straight out of residency. Although numerous teaching awards had validated my career path, the best rewards were from the learners who often presented to my open door to ask advice about residency choices, balancing family life, personal dilemmas, or patient problems. That “aha moment” during rounds when the junior student made the connection between theory and clinical application got me up in the morning. So how is …