Academic medicine : journal of the Association of American Medical Colleges
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Although there have been a number of studies of cheating in universities, surprisingly little has appeared recently in the literature regarding academic dishonesty among medical students. ⋯ About 5% of the medical students surveyed reported cheating during the first two years of medical school. The students appeared resigned to the fact that cheating is impossible to eliminate, but they lacked any clear consensus about how to proceed when they became aware of cheating by others. The guidance students appear to need concerns not so much their own ethical behaviors as how and when to intervene to address the ethical conduct of their peers.
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This is the report of a study undertaken by the Association of America n Medical Colleges to estimate the total amount of clinical revenues that are used to support the academic mission of U. S. medical schools. The study was prompted by an awareness that recent market-driven changes in health care organization and financing threaten the structure of medical school financing that has evolved over the last half-century. ⋯ However, unravelling the complex web of subsidies and cross-subsidies that characterizes medical school-hospital relationships proved to be beyond the capability of the present investigation. There is considerable evidence that changes in health care organization and financing will make it unlikely that the current level of support from practice plans and volunteer faculty can be sustained and that in some cases it is already diminishing. The restructuring of medical school financing to absorb the impact of this decline of support, which comes on top of reductions in indirect cost recoveries and pressures to lower state appropriations, constitutes one of the major challenges medical schools will face in the years ahead.
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Despite the fundamental transformations occurring in health care, academic medicine can maintain, and actually enhance, its value to society. But to do so will require a shared vision of where academic medicine should go. The author offers his own vision, one that includes (1) establishing true partnerships between medical schools and the communities they serve; (2) elevating prevention and health maintenance to equal status with diagnosis and treatment; (3) addressing pressing social problems, such as drug abuse, teenage pregnancy, and domestic violence; (4) assuming a leadership role in containing health care costs; (5) harnessing information technology to develop, disseminate, and implement comprehensive clinical information systems, and to provide the public with reliable medical information; (6) fostering racial, ethnic, and gender parity in medicine; (7) carrying out appropriate downsizing and restructuring of the academic medicine enterprise; (8) addressing forcefully the workforce needs for physicians and medical scientists; (9) improving the education of medical students and residents and fostering the conduct of clinical research by creative use of the integrated academic health care systems that teaching hospitals are becoming; (10) developing regional educational consortia to guide important aspects of medical students' and residents' education; (11) building a learning network so that meaningful cross-talk and dissemination of lessons learned can occur among all segments of the academic medicine community; and (12) creating a permanent planning process to guide academic medicine's future. The author concludes that if academic medicine adheres to its tradition of public service and professionalism, its future can be as glorious as its past.
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Using national databases of the Association of American Medical College, the authors employed logistic regression analysis to show the relative predictive influences of selected demographic, structural, attitudinal, and educational variables on the specialty careers choices of 1995 U. S. medical school graduates. Plans to pursue certification in family practice or an unspecified generalist career could be predicted with moderate success, while choices of general internal medicine and general pediatrics could not. ⋯ In terms of the predictive values of the input variable in this study, career decisions for the other two generalist specialties--general internal medicine and general pediatrics--were essentially a crapshoot, either because the tactics to promote interest in these fields were ineffective (or confounded), or because the efforts were underdeveloped. Moreover, the statistical models of this study employed quantifiable variables that can be discerned and manipulated to guide the result, whereas medical students tend to identify less tangible elements as more powerful factors influencing their career choices. The results sharpen the strategic focus, but must be combined with those of other, descriptive analysis for a more complete understanding of graduating students' career decisions.
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Comparative Study
Psychometric properties of a standardized-patient checklist and rating-scale form used to assess interpersonal and communication skills.
The results show that the SP checklist scores and the SP ratings of interpersonal and communication skills have comparable psychometric properties. The reliabilities of the five-item rating form (.76) and the single global rating of patient satisfaction (.70) were slightly higher than the reliability of the 17-item checklist (.65); this finding is of particular significance, given the greater length of the checklist. Also, the checklist scores and ratings appear to be measuring the same underlying dimension, with correlations of the checklist with the five ratings and with the single global rating being .82 and .81, respectively. ⋯ Thus, the faculty ratings would provide a basis for case development and refinement, including scoring and standard setting, and scores on the checklist would serve as a proxy for the gold-standard faculty ratings. The study suggests that SP ratings may be more efficient and more reliable than SP checklists for assessing interpersonal and communication skills. The study also demonstrates that global ratings by SPs (or by expert physician observers) can provide a basis for SP-test construction.