Journal of general internal medicine
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To determine the response of physicians to a noncoercive prediction rule for the triage of emergency department patients with chest pain. ⋯ The physicians reported that they looked at the prediction rule during the triage of 115 (46%) of the 252 patients. The likelihood of using the prediction rule decreased significantly with increasing level of physician training. The most common reasons given for disregarding the prediction rule were confidence in unaided decision making and lack of time. The physicians reported that of the 115 cases for which the prediction rule was used, only one triage decision (1%) was changed by it. Future research should explore how prediction rules can be designed and implemented to surmount the barriers highlighted by these data.
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Comparative Study
Addressing alcohol use among primary care patients: differences between family medicine and internal medicine residents.
To determine whether rates of addressing alcohol use differed between family medicine and internal medicine residents, and to determine whether attitudes, confidence, and perceptions affected these relationships. ⋯ Rates of addressing alcohol use differed for internal medicine and family medicine residents, but were not due to differences in resident perceptions and attitudes.
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Randomized Controlled Trial Clinical Trial
Impact of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) on the speed of triage decision making for emergency department patients presenting with chest pain: a controlled clinical trial.
Emergency department (ED) triage for acute cardiac ischemia in the primary teaching hospital in Geneva, Switzerland, is very accurate, but at the cost of very long ED stays. Thus, the authors sought: 1) to determine the impact of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI), incorporated into a computerized electrocardiograph, on length of stay and speed of triage decision making for ED patients presenting with symptoms suggesting acute cardiac ischemia, and 2) to study the ACI-TIPI's impact on physicians of different training levels. ⋯ For ED patients with acute cardiac ischemia evaluated by novice clinicians, the ACI-TIPI substantially speeded ED decision making and triage. The suggestion of an impact on different cardiac ischemia subgroups and mortality deserves further larger clinical trials.
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This paper describes teaching and learning methods that can be used to build the competencies needed by the generalist physician. Supervised patient care, problem-based learning, and ongoing feedback through standardized patients all have proven efficacy in several domains. ⋯ The authors review each method's principles, relationship to generalist competencies, examples of effective applications, and challenges to successful implementation. Where possible, they summarize what is known about the relationships of learning and teaching methods to career choices in generalism.