Academic medicine : journal of the Association of American Medical Colleges
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The authors describe the development, implementation, and institutionalization at Harvard Medical School of a promotion ladder that recognizes the teaching and scholarly contributions of full-time clinical faculty. They also discuss the challenges that arose during this process, for example, how to make the new track creditable and attractive to both the appointed faculty and the faculty at large. The criteria developed for promotion focus on a candidate's skills and accomplishments in teaching, scholarship, clinical work, and departmental service. ⋯ The development of this teacher-clinician ladder has had a positive influence on faculty who are committed to teaching by allowing recognition of their contributions in a track held to be the equal of the other full-time tracks in a medical faculty traditionally committed to research and patient care. Data are given for the 70 faculty who were promoted over the five years from 1989 to 1994. The true success of this promotion ladder will be measured only over time through its impact on the educational enterprise within the medical school and its hospitals, and its capacity to both successfully advance the careers of qualified medical educators and further the development of the field of medical education.
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Little is known about how internal medicine residents train for and practice telephone management. To address this deficiency, a national survey of program directors at accredited internal medicine training sites was conducted to evaluate residents' training for and practice of telephone medicine. ⋯ Few internal medicine programs offered training in telephone management. When training occurred, it was usually limited and informal. Most program directors felt that training was important and that current training efforts were unsatisfactory, emphasizing the need for curriculum development and implementation in telephone management.
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This study was undertaken to promote communication among faculty regarding the impact of a proposed goal that 50% of the graduates of Jefferson Medical College enter generalist careers. Since the opinions and attitudes of faculty regarding career decisions may directly or indirectly influence students, the authors investigated faculty's views of the optimal ratio of primary care to non-primary care physicians in the workforce and their perceptions of the effect on medical education, research, and health care delivery if the 50% goal were to be mandated. ⋯ The faculty members' positive and negative views of the proposed reform can provide useful information to the institution in understanding the potential impediments to increasing the numbers of generalist graduates. The generalists had significantly different views from the subspecialists about the impact of increasing the proportion of primary care physicians on health care delivery and research. In general the primary care physicians were more likely to view the proposed changes as beneficial than were the non-primary care physicians.
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Despite recent major changes in the practice of medicine, there has been relatively little change in medical education, particularly in the clinical years. Important areas such as ethics, domestic violence, nutrition, preventive medicine, and clinical decision making have been neglected in the curriculum. However, in 1994 the UCLA School of Medicine began to implement Doctoring III, a multidisciplinary, centralized, longitudinal course that spans the third year of medical school. ⋯ In the small groups, students and faculty follow and manage a panel of simulated patients over the course of the year. The students thus have the opportunity to develop a sense of the progression of common illnesses over time and to explore related ethical, social, and other concerns. The approach taken in Doctoring III has enabled the UCLA School of Medicine to overcome many barriers to curricular change, and it may serve as a model for incorporating the teaching of underrepresented topics in the clinical years.
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Accustomed to congressional and industry support, patient-centered clinical research is at a crossroads in 1995. Forced to look into the next century by the seven-year budget cycle selected by Congress, its path seems hindered by threatened cuts in funding for the National Institutes of Health (NIH), cost pressures on private-sector organizations that support research initiatives, and market restraints on the academic health centers that traditionally have served as research bases for many clinical investigators. ⋯ How these issues are approached--let alone resolved--is significant not only for the future of clinical research but also for the health of the public. The author discusses these issues and concludes with a list of specific questions that must be addressed in confronting policy issues of clinical research.