Scott A. Fields

Impact of the presence of a third-year medical student on gross charges and patient volumes in 22 rural community practices.

No abstract available.

The ADVANCE network: accelerating data value across a national community health center network

The ADVANCE (Accelerating Data Value Across a National Community Health Center Network) clinical data research network (CDRN) is led by the OCHIN Community Health Information Network in partnership with Health Choice Network and Fenway Health. The ADVANCE CDRN will ‘horizontally’ integrate outpatient electronic health record data for over one million federally qualified health center patients, and ‘vertically’ integrate hospital, health plan, and community data for these patients, often under-represented in research studies. Patient investigators, community investigators, and academic investigators with diverse expertise will work together to meet project goals related to data integration, patient engagement and recruitment, and the development of streamlined regulatory policies. By enhancing the data and research infrastructure of participating organizations, the ADVANCE CDRN will serve as a ‘community laboratory’ for including disadvantaged and vulnerable patients in patient-centered outcomes research that is aligned with the priorities of patients, clinics, and communities in our network.

Principles of clinical medicine: Oregon Health Sciences University School of Medicine

In 1992, the School of Medicine at Oregon Health Sciences University inaugurated a Principles of Clinical Medicine (PCM) course as part of an overall curricular revision. The PCM course, which covers the first and second years of medical school, integrates material from ten separate courses in the previous curriculum. Students learn longitudinally over the two years, rather than “cramming” discrete areas of knowledge and then moving on. Course sessions are related to concurrently taken basic science classes. Meeting two afternoons per week, the PCM course offers preceptorships, health care issues sessions, and patient examination sessions. The PCM course aims to encompass the body of knowledge, skills, and attitudes necessary to become a competent physician. First- and second-year students have more opportunities than previously to interact with patients and practicing physicians in the community. Competition between learning areas, student perceptions of “soft” and “hard” courses, teacher recruitment, and administrative burnout are ongoing difficulties, while faculty recognition and development, administrative commitment and flexibility, and student and faculty feedback all contribute to the success of the course. The PCM course is now the backbone of the first two years of medical school and creates a solid foundation for the third and fourth years.

Principles of clinical medicine: an interdisciplinary integrated 2-year longitudinal course.

In keeping with the Report of the Panel on the General Professional Education of the Physician ( Association of American Medical Colleges 1984 ), Oregon Health Sciences University (OHSU) School of Medicine is in the midst of revising its curriculum. After a 4‐year process, the Curriculum Committee mandated development of the Principles of Clinical Medicine course, a 2‐year longitudinal course integrating input from both basic and clinical science departments. We describe the steps leading to the courses implementation, its administrative and organizational structure, the evaluation of student performance, teacher training, course curriculum, and the use of interdisciplinary teaching. This course embodies many of the changes called for in the AAMC Report and serves as a model for interdisciplinary education.

Patient-Provider Communication: Does Electronic Messaging Reduce Incoming Telephone Calls?

Purpose: Internet-based patient portals are increasingly being implemented throughout health care organizations to enhance health and optimize communication between patients and health professionals. The decision to adopt a patient portal requires careful examination of the advantages and disadvantages of implementation. This study aims to investigate 1 proposed advantage of implementation: alleviating some of the clinical workload faced by employees. Methods: A retrospective time-series analysis of the correlation between the rate of electronic patient-to-provider messages—a common attribute of Internet-based patient portals—and incoming telephone calls. The rate of electronic messages and incoming telephone calls were monitored from February 2009 to June 2014 at 4 economically diverse clinics (a federally qualified health center, a rural health clinic, a community-based clinic, and a university-based clinic) related to 1 university hospital. Results: All 4 clinics showed an increase in the rate of portal use as measured by electronic patient-to-provider messaging during the study period. Electronic patient-to-provider messaging was significantly positively correlated with incoming telephone calls at 2 of the clinics (r = 0.546, P < .001 and r = 0.543, P < .001). The remaining clinics were not significantly correlated but demonstrated a weak positive correlation (r = 0.098, P = .560 and r = 0.069, P = .671). Conclusions: Implementation and increased use of electronic patient-to-provider messaging was associated with increased use of telephone calls in 2 of the study clinics. While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change not be based on the idea that it will alleviate clinical workload.

Addition of a clinical pharmacist to an inpatient family medicine service.

Pharmacists can play an important role in improving the continuity of medication management for hospitalized patients.[1][1],[2][2] Interventions, including medication reconciliation at the time of admission and discharge, may help to reduce hospital readmissions and even patient mortality.[3][3

Early Identification of Students at Risk for Poor Academic Performance in Clinical Clerkships

Many medical schools have revised, or are in the process of revising, their curricula. The impetus for this curricular change has been dependent on many factors. These factors include grant initiatives emphasizing the development of curricula to promote generalism and the Association of American Medical Colleges’ Medical School Objectives Project (MSOP), as well as significant shifts in the health care system, such as the growing influence of managed care. The more innovative curricular revisions to date have included multidisciplinary, integrated courses with longitudinal curricula and early clinical experiences throughout the first two years (the preclinical curriculum). Oregon Health Sciences University (OHSU) School of Medicine implemented its curriculum revision in 1992. The result of this effort was the restructuring of the first two years of the curriculum from 24 specific discipline-based courses to ten interdisciplinary units. One of the units, the Principles of Clinical Medicine (PCM), is a longitudinal two-year course composed of small-group activities half a day each week and a weekly half-day clinical preceptorship. In addition, there are nine integrated basic science courses in the first two years, and a one-week course, Transition to Clerkship, occurs at the end of the second year. The core clerkships, constituting the entire third year, include medicine, surgery, obstetrics–gynecology, family medicine, psychiatry, pediatrics, and rural primary care. Each of these clerkships is six weeks in duration with the exception of medicine, which occurs in two six-week blocks. The premise for this study was that early identification of medical students who are at academic risk provides a basis for intervention with individualized remedial programs. Previously, studies have investigated predictors of performance for years one and two of medical school. Little has been done to address early identification of students at risk for academic difficulty in the third year of medical school. The hypothesis was that performance in PCM during the predominantly pre-clinical curriculum of the first two years predicts students at risk for academic difficulty in the clinical clerkships. Accordingly, this study analyzed the relationship between parameters of student assessment, including a number of admission, curriculum, and standardized testing criteria, and an accepted standard of graded performance in the third-year core clerkships.

Principles of clinical medicine: A multidisciplinary, integrated, two-year longitudinal curriculum

No abstract available.

Early longitudinal assessment of clinical skills and performance in the basic sciences

No abstract available.

Response: Re: patient-provider communication: Does electronic messaging reduce incoming telephone calls?

To the Editor: We appreciate the thoughtful correspondence. Our article addresses the question of what would happen to phone call volume in the face of expanding electronic messaging. Although we offered multiple hypotheses about why we had unexpected findings, the reason for this outcome is unclear