Robert S. Blacklow

Brief screens for mental disorders in primary care

We evaluated a set of diagnostic screens for mental disorders in primary care. A self-administered screening questionnaire containing 26 items testing for multiple mental disorders was completed by 1,001 patients. Brief diagnostic modules, structured for psychiatric diagnoses, were subsequently administered to each patient by a research nurse. Operating characteristics of the screens were as follows: alcohol dependence (sensitivity [SE] 0.75; positive predictive value [PPV] 0.58; [κ] 0.63), drug dependence (SE 0.50; PPV 0.50; κ 0.50), generalized anxiety disorder (SE 0.74; PPV 0.44; κ 0.44), major depressive disorder (SE 0.71; PPV 0.52; κ 0.50), obsessive compulsive disorder (SE 0.71; PPV 0.15; κ 0.21), and panic disorder (SE 0.71; PPV 0.43; κ 0.48). Other chance-corrected measures of agreement are also reported, and criterion validity of the screens is examined. The results provide evidence that the screens discriminate between patients with symptomatology meeting established diagnostic criteria and those without. They detected previously unrecognized cases in this study and may prove to be valuable tools for psychiatric diagnosis in primary care.

Bladder cancer: Race differences in extent of disease at diagnosis

Blacks are less likely than whites to develop bladder cancer; although once diagnosed, blacks experience poorer survival. This study sought to examine multiple biological and behavioral factors and their influence on extent of disease.

Recognition of emotional distress in physically healthy primary care patients who perceive poor physical health

This study examines the recognition and treatment of emotional distress in physically healthy primary care patients who perceive themselves to be in fair or poor physical health. Patients (N = 892) from three private primary care practices completed a mental health screening form prior to their medical visit which included an overall assessment of their physical health (1 = excellent, 2 = good, 3 = fair, 4 = poor). Following the visit, their physicians completed a questionnaire that included the same physical health assessment item. The study group, physically healthy patients who perceive poor physical health (HPPPH), included those patients who rated their physical health as 2 or 3 points more impaired than it was rated by their physician. HPPPH (N = 39) were significantly more likely than other patients (N = 853) to report a prior psychiatric hospitalization (p < 0.05), marital difficulties (p < 0.01), recent missed work due to a mental health problem (p < 0.001), and a range of anxiety, depressive, and psychosomatic symptoms. However, HPPPH were also significantly more likely than other patients to receive excellent emotional health ratings (p < 0.001) from their physicians and were less likely to receive mental health treatment (p < 0.05). Detection of emotional distress may be particularly difficult in physically healthy patients who have low physical health perceptions. Identification of pessimistic physical health perceptions may serve as an indicator for underlying emotional distress.

Differences between black and white patients with cancer of the uterine corpus in interval from symptom recognition to initial medical consultation (United States).

To determine whether Black women with symptoms of uterine corpus cancer had longer times from symptom recognition to initial medical consultation than did White women in the United States, 331 newly diagnosed patients living in Atlanta (GA), New Orleans (LA), and San Francisco/Oakland (CA) during 1985–87 were interviewed to collect information on symptoms, dates of recognition and consultation, and other factors that might affect the interval. Data were analyzed to estimate medical consultation rates and rate ratios following sysptom recognition. Median recalled times between symptom recognition and consultation were 16 days for Black women and 14 days for White women. Although poverty, having no usual source of healthcare, and other factors were associated with lower consultation rates, the adjusted rate among Black women was only somewhat lower (0.87) than among White women, and the 95 percent confidence interval (CI=0.58–1.31) was consistent with no true difference between the races. In addition, the median time to consultation for women with stage IV cancer was only 15 days longer than the time (14 days) for the women with stage I cancer. These results suggest that time from symptom recognition to initial medical consultation does not contribute importantly to the more advanced stage cancer of the uterine corpus commonly found among Black women.

Medical student counseling: the Rush Medical College Adviser Program.

An adviser program has been instituted at Rush Medical College which utilizes specially selected and trained faculty members and provides comprehensive counseling with continuity of contact between adviser and student through the four years of medical school. In this paper, the authors describe the development of the program and the evaluations used to determine its efficacy. The authors conclude that the personal characteristics and time commitment of the advisers are of primary importance rather than their training discipline, that continuity of contact between student and adviser fosters the development of the most beneficial relationships, that advisers require special training during the entire time of their service as advisers, and that the program and the advisers require continual monitoring so that deficient performance and changing needs can be promptly identified.

Gender Comparisons Prior to, during, and after Medical School Using Two Decades of Longitudinal Data at Jefferson Medical College.

Similarities and differences prior to, during, and after medical school between 3,541 men and 1,121 woman graduates of Jefferson Medical College were investigated. Gender comparisons were made on examination scores, admissions interview ratings, competence ratings in residency, specialty choice, board certification, income estimates, and academic appointments. Results indicated that prior to medical school, women scored higher on verbal tests, whereas men outscored women on quantitative and science tests. During medical school, men performed better than women in the basic science examinations, but not in the clinical science examinations. Men and women had similar postgraduate competence ratings except that women were rated higher than men in the socioeconomic aspects of patient care. Women had lower board certification rates, expected less income, and had a higher proportion offaculty appointments than did men. Gender differences in specialty choices, faculty appointments, and estimated income could have important implications for health care manpower

Delays in completing medical school: Predictors and outcomes

This article addresses whether delayed graduation due to academic difficulties in the early years of medical school can be predicted early and whether such difficulties are likely to be manifested in later clinical clerkships and residency. A group of 103 graduates who entered Jefferson Medical College between 1970 and 1984 and who required more than 4 years to complete their studies due to academic difficulties were compared to a random sample of 120 on‐time graduates. Statistically significant differences were observed between delayed and on‐time graduates on measures of performance before, during, and after medical school in favor of on‐time graduates. Scores of 8 on the Medical College Admission Test and an undergraduate science grade‐point average of 3.25 were found to be pivotal points below which the likelihood of delayed graduation was higher than the likelihood of on‐time graduation. Discriminant analyses indicated that 76% of delayed and on‐time graduates could correctly be classified into their...

Understanding the costs of ambulatory care training.

While patient care has been shifting to the ambulatory setting, the education of health care professionals has remained essentially hospital-based. One factor discouraging the movement of training into community-based ambulatory settings is the lack of understanding of what the costs of such training are and how these costs might be offset. The authors describe a model for ambulatory care training that makes it easier to generalize about to quantify its educational costs. Since ambulatory care training does not exist in a vacuum separate from inpatient education, the model is compatible with the way hospital-based education costs are derived. Thus, the models elements can be integrated with comparable hospital-based training cost elements in a straightforward way to allow a total-costing approach. The model is built around two major sets of variables affecting cost. The first comprises three types of costs--direct, indirect, and infrastructure--and the second consists of factors related to the training site and factors related to the educational activities of the training. The model is constructed to show the various major ways these two sets of variables can influence training costs. With direct Medicare funding for some ambulatory-setting-based education pending, and with other regulatory and market dynamics already in play, it is important that educators, managers, and policymakers understand how costs, the characteristics of the training, and the characteristics of the setting interact. This model should assist them. Without generalizable cost estimates, realistic reimbursement policies and financial incentives cannot be formulated, either in the broad public policy context or in simple direct negotiations between sites and sponsors.

Class ranking models for deans' letters and their psychometric evaluation.

P O S T G R A D U AT E A N D C A R E E R : CLINICAL COMPETENCE FURTHER PSYCHOMETRIC EVALUATIONS OF A CLASS RANKING MODEL AS A PREDICTOR OF GRADUATES’ CLINICAL COMPETENCE IN THE FIRST YEAR OF RESIDENCY Robert S. Blacklow, Carla E. Goepp, Mohammadreza Hojat This study was designed to investigate further the psychometrics of a class-ranking model in which a weight of one-third was assigned to performance measures in basic sciences and a weight of two-thirds to ratings on six core clerkships. The first part of the study involved 215 graduates of Jefferson Medical College who, based on the ranking model, had been in the top and bottom quarters of the classes of 1991 and 1992. Six faculty, who did not know the graduates’ ranks but were familiar with their performances and characteristics, were asked to judge the graduates’ potentials to become competent physicians. The graduates’ ranks according to the model were then compared with the ratings they received from the faculty. The second part of the study investigated whether there was a linear relationship between class ranks and ratings of postgraduate competence, by using directors’ ratings of the data-gathering skills of 598 graduates (1986-1990) at the end of their first year of residency. A concordance rate of 85% was obtained between the graduates’ ranks and the ratings they received from the medical school faculty, which supports the criterion-related validity of the ranking model. In addition, class ranks were linearly related to ratings of postgraduate competence. However, women and graduates who had been low achievers in medical school were less likely to have given permission for collecting postgraduate ratings, which led to range restriction and a possible under-estimation of the validity of the model. The psychometric evidence supports the class-ranking model, but other schools should exercise caution in employing the model until they accumulate evidence from data obtained from their own students. Academic Medicine. 1993; 68: 295-297. 71 J e f f e r s o n L o n g i t u d i n a l S t u d y o f M e d i c a l E d u c a t i o n RELATIONSHIP BETWEEN PERFORMANCE IN MEDICAL SCHOOL AND POSTGRADUATE COMPETENCE Joseph S. Gonnella, Mohammadreza Hojat A sample of 441 graduates (between 1971 and 1981) of Jefferson Medical College who pursued their medical training in internal medicine, pediatrics, and obstetrics/gynecology was selected. It was hypothesized that the relationship between measures of academic achievement in medical school and measures of postgraduate performance would vary in different specialty programs. The hypothesis was confirmed by comparing graduates in the three specialties on grades in medical school, scores on the examinations of the National Board of Medical Examiners, and ratings in four areas of competence in the first postgraduate year (that is, medical knowledge, data-gathering skills, clinical judgment, and professional attitudes). It was also hypothesized that the strength of the relationship would vary at different levels of performance within the specialty programs. This was confirmed for some of the variables. The results indicated that inappropriate conclusions may be drawn about the relationship between performance before and after graduation from medical school if specialty differences and levels of performance are ignored. Journal of Medical Education. 1983; 58: 697-685. 72 A B S T R A C T S P O S T G R A D U AT E A N D C A R E E R : CLINICAL COMPETENCE

Sensitizing Residents to Moral Issues by Case Discussions.

No abstract available.