William Shore

Nonvenereal transmission of gonococcal infections to children

T H E I N c I D E N 12 E of gonorrheal infections among adults has increased markedly in recent years? Branch and Paxton ~ have called attention to a concurrent rise among young children in an urban area. A high incidence of gonorrhea is found in the general population of southwestern Alaska? Concurrently, an unusually high incidence of gonococcal infections has been observed in young children. In contrast to previous reports of gonococcal infections in children,2, ~, s we have found that under certain environmental conditions, indirect or nonvenereal contact with an infected adult, rather than sexual contact, may play a significant role in the transmission of gonococcal infections to young children. The purpose of this report is to alert physicians to the increasing incidence of gonococcal infections in children, as well as to the possibility of an unusual mode of transmission.

Development of a longitudinal integrated clerkship at an academic medical center

Abstract In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSFs traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants’ career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

What did we learn about the impact on community-based faculty? Recommendations for recruitment, retention, and rewards.

All ten schools participating in the Interdisciplinary Generalist Curriculum (IGC) Project were required to offer students significant generalist longitudinal preceptorship experiences during the first two years of medical school. Each school needed to recruit and then retain many new preceptors to meet the continued large demand. Effective recruitment was usually carried out by established community physicians and/or qualified staff coordinators. Retention of preceptors required establishing regular and succinct communications, quick response to problems, and flexible faculty development programs. For rewards, preceptors primarily requested acknowledgment and appreciation, along with tangible rewards such as decreased fees for continuing medical education and library or e-mail access. Preceptors continue to state that they teach because of the “joys of teaching” even in the current environment with increased demands for productivity. This article describes what has been learned about recruitment, retention, and rewards for community preceptors and how to maximize the positive impacts and minimize the negative impacts of teaching for community preceptors.

Reflections-on-action: medical students' accounts of their implicit beliefs and strategies in the context of one-to-one clinical teaching.

No abstract available.

Understanding the needs and concerns of senior faculty in academic medicine: building strategies to maintain this critical resource.

Purpose The average age of medical school faculty is increasing, with 30% over age 55 in 2007. In 2012, 56% of Society of Teachers of Family Medicine (STFM) members were at least 50 years old. The authors sought to identify the transition and faculty development needs of this group of senior faculty. Method In 2012 the authors electronically surveyed 1,708 U.S. STFM members who were 50 or older, asking about demographics, highest degree, primary employer, career options considered in the previous year, issues of concern, mentoring needs, retirement plans, and likely activities in retirement. Results The response rate was 45%, with 73% MD/DOs, 62% men, 89% white, and 64% employed by academic institutions. The most frequent issues of concern were balancing personal and work time (67%), maintaining health (66%), and planning for retirement (60%). Nearly a third had considered career advancement, changing employers, or reducing full-time employment. Fifty-one percent were not receiving mentoring of any kind, but 47% reported they would like to have a mentor. Sixty-four percent were planning to retire; in retirement, 75% said they would like to remain active in teaching and 55% in mentoring. Conclusions Senior faculty in family medicine have significant career concerns and mentoring needs as they approach retirement, and these faculty can be valuable resources after retirement. As the age of faculty continues to rise, medical schools and specialty organizations can develop specific programs to meet the needs of these medical educators and better use this expertise in a time of limited resources.

Changes in medical students' exposure to and attitudes about drug company interactions from 2003 to 2012: a multi-institutional follow-up survey.

Purpose To ascertain whether changes occurred in medical student exposure to and attitudes about drug company interactions from 2003–2012, which factors influence exposure and attitudes, and whether exposure and attitudes influence future plans to interact with drug companies. Method In 2012, the authors surveyed 1,269 third-year students at eight U.S. medical schools. Items explored student exposure to, attitudes toward, and future plans regarding drug company interactions. The authors compared 2012 survey data with their 2003 survey data from third-year students at the same schools. Results The 2012 response rate was 68.2% (866/1,269). Compared with 2003, in 2012, students were significantly less frequently exposed to interactions (1.6/month versus 4.1/month, P < .001), less likely to feel entitled to gifts (41.8% versus 80.3%, P < .001), and more apt to feel gifts could influence them (44.3% versus 31.2%, P < .001). In 2012, 545/839 students (65.0%) reported private outpatient offices were the main location of exposure to pharmaceutical representatives, despite spending only 18.4% of their clerkship–rotation time there. In 2012, 310/703 students (44.1%) were unaware their schools had rules restricting interactions, and 467/837 (55.8%) planned to interact with pharmaceutical representatives during residency. Conclusions Students in 2012 had less exposure to drug company interactions and were more likely to have skeptical attitudes than students in 2003. These changes are consistent with national organizations’ recommendations to limit and teach about these interactions. Continued efforts to study and influence students’ and physician role models’ exposures to and attitudes about drug companies are warranted.

Relationships Between Drug Company Representatives and Medical Students: Medical School Policies and Attitudes of Student Affairs Deans and Third-Year Medical Students

ObjectivesThe authors sought to ascertain the details of medical school policies about relationships between drug companies and medical students as well as student affairs deans’ attitudes about these interactions.MethodsIn 2005, the authors surveyed deans and student affairs deans at all U.S. medical schools and asked whether their schools had a policy about relationships between drug companies and medical students. They asked deans at schools with policies to summarize them, queried student affairs deans regarding their attitudes about gifts, and compared their attitudes with those of students who were studied previously.ResultsIndependently of each other, 114 out of 126 deans (90.5%) and 114 out of 126 student affairs deans (90.5%) responded (identical numbers are not misprints). Ten schools had a policy regarding relationships between medical students and drug company representatives. Student affairs deans were much more likely than students to perceive that gifts were inappropriate.ConclusionThese 2005 policies show trends meriting review by current medical schools in considering how to comply with the 2008 Association of American Medical Colleges recommendations about relationships between drug companies and medical students or physicians.

The Interdisciplinary Generalist Curriculum Project at the University of California, San Francisco.

The Interdisciplinary Generalist Curriculum (IGC) Project came at a pivotal time in curriculum development at the University of California, San Francisco, School of Medicine. In the three years prior to the project, the curriculum committee had considered implementation of early longitudinal clinical experiences. This had not been proposed as a primary care experience. Introduction of generalist skills, with the goal of increasing numbers of students choosing generalist residencies, presented significant challenges at this tertiary care and research-oriented medical school. The new IGC course, Foundations of Patient Care, consists of on-campus lectures, small-group sessions, physical examination skills instruction, and a six-quarter preceptorship. As proposed, the school increased teaching of generalist skills and competencies and developed a large pool of primary care preceptors. There was no change in the number of graduates choosing primary care. The strong collaboration that resulted from the development of this new course served as a catalyst for major curricular reform now under way at this medical school.

Adolescent Health Care Maintenance in a Teen-Friendly Clinic

Adolescence is marked by complex physical, cognitive, social, and emotional development, which can be stressful for families and adolescents. Before the onset of puberty, providers should clearly lay the groundwork for clinical care and office visits during the adolescent years. This article addresses the guidelines and current legal standards for confidentiality in adolescent care, the most frequently used psychosocial screening tools, and current recommendations for preventive health services and immunizations. Through the creation of teen-friendly clinics, primary care providers are well positioned to offer guidance and support to teens and their parents during this time of transition and growth.

Adolescent medicine. Preface.

Adolescence is a normal developmental stage, and the changes that accompany this developmental journey may be exciting, challenging, and even frightening for teens, their families, and their health care providers. It is a period of complex physical, cognitive, social, and emotional development that spans the transition from childhood to adulthood. Adolescence typically begins with the physical changes of puberty that occur during the preteen years and ends with the successful adoption of adult roles and responsibilities by the early to mid-twenties. During these years, teens often establish habits and refine beliefs that remain with them throughout much of their adult lives. These habits and beliefs are influenced by parents, peers, religious and ethnic communities, and society at large. Parents and physicians often worry about negative influences during the adolescent years. Nevertheless, healthy and supportive relationships between youth, their family, friends, and other caring adults can provide a framework for developing positive social behaviors and maintaining resiliency in the face of personal or social stress. This issue of Primary Care: Clinics in Office Practice focuses on common diagnoses and health issues that often first present in primary care offices along with guidelines to create the supportive environment that is fundamental to the care of adolescents and their families. The first two articles focus on more “routine” aspects of the typical primary care adolescent office visit. The first article reviews health care maintenance and screening recommendations, describes confidentiality standards for working with adolescents, and provides suggestions for creating a teen-friendly clinic. The second article describes normal adolescent growth and development followed by a description of the approach to patients who vary in their development. The subsequent articles are organized in a format that resembles the HEEADSS Screen, a well-known adolescent psychosocial screening tool. In the Home section,