Roger A. Girard

A National Study of Internal Medicine and Its Specialties: I. An Overview of the Practice of Internal Medicine

A nationwide study of 24 medical and surgical specialties has been conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. This article is the first in a series reporting findings for general internal medicine and 10 subspecialties of internal medicine. Populations for these 11 specialties are defined and enumerated, and the specialties are compared in terms of demographic and geographic distribution. Practice comparisons are presented based on characteristics such as workload, allocation of professional time, location of encounters with patients, distribution of primary problem diagnoses, and projections of annual patient encounters. Forthcoming specialty-specific articles will present highly detailed information for general internal medicine and for the subspecialties of cardiology, gastroenterology, pulmonary disease, allergy, hematology, endocrinology, nephrology, medical oncology, rheumatology, and infectious diseases.

A monte carlo evaluation of interactive multidimensional scaling

Interactive Scaling with Individual Subjects (ISIS) developed by Young & Cliff [1972], is a method involving interaction between subject and computer in real time to determine which judgments made by the subject are critical to the definition of a dimensional structure. The procedure is based on the mathematical fact that it is possible to define a space ofR dimensions in terms of only the interpoint distances between all stimuli being scaled and a subset of (R+1) of these stimuli. For errorless judgments, any subset of (R + 1) stimuli is appropriate. However, fallible data require that the subset consist of stimuli that are maximally dissimilar, and the ISIS procedure is designed to obtain such an optimum subset (a “basis”).This research evaluates a modified version of ISIS with respect to (a) a metric MDS analysis based on all possible pairs of the stimuli, and (b) a metric MDS analysis based on a subset of one-third of the possible pairs, or about the same number as that required by ISIS. Results show that the ISIS method achieves better fit than (b) at low error levels, and may also achieve better fit than (b) at higher error levels if the size of the basis is increased. The more stimuli in the basis the more indices of fit approach those of (a).A new method of introducing error in MDS studies is used in the evaluation.

Interscal: A TSO FORTRAN IV Program for Subject Computer Interactive Multidimensional Scaling‡

INTERSCAL is a program for subject-computer interactive multidimensional scaling. The program analyzes subsets of judgments of similarity as they are given and picks out dimension-defining stimuli; this capability allows for a great reduction in the number of judgments. Program features and options are described.

Neurosurgery in the United States: a log-diary study

The Division of Research in Medical Education and of the University of Southern California, with the cooperation and assistance of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, has conducted a national study of the professional activities of neurological surgeons in the United States. One of a series of 24 surveys of medical and surgical specialties, the survey obtained information on patient workloads, the allocation of physician time, the characteristics of patients and the circumstances under which they were seen, patient diagnoses, and the care that was provided--including whether an operation was performed. This paper provides a selection of the findings deemed most relevant to manpower issues in neurosurgery. A later paper will examine regional differences in patient care, including the frequency with which selected surgical procedures are used for different clinical conditions.

AN ASSESSMENT OF THE CONTENT OF MEDICAL PRACTICE IN THE UNITED STATES: PROFILES OF PHYSICIANS IN FIVE SPECIALITIES

ABSTRACT The University of Southern California has conducted a series of 24 surveys of the professional activities of physicians and surgeons in the United States. The surveys encompass more than 10,000 respondents representing 65.8% of all practising physicians in the United States and its territories. Using a specially‐developed “log‐diary” recording instrument, these physicians reported data on the care they provided during hundreds of thousands of encounters with their patients. This article provides an exposition of the studys unique methodology, presents illustratative data for 5 of the 24 specialities surveyed (cardiology, family practice, general internal medicine, orthopaedic surgery and psychiatry), and discusses the studys relevance and implications for medical education.