Academic medicine : journal of the Association of American Medical Colleges
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Comparative Study
A comparison of Jefferson Medical College graduates who chose emergency medicine with those who chose other specialties.
Fifty-three graduates of Jefferson Medical College who chose emergency medicine (EM) over the decade from 1981 through 1990 were compared with the other graduates of that school during that decade who chose other specialties, using the database of the school's longitudinal study of its students. As seniors, those who chose EM had the highest debt of seniors going into any specialty. ⋯ The students who chose EM also indicated their great willingness to see patients from low-income households, and were willing to spend more of their practice time serving these groups than were the students who chose the other specialties. The authors discuss these findings as related to the nature of EM and medical school graduates' choices of specialties.
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Comparative Study
Comparing assessments of medical students' potentials as residents made by the residency directors and deans at two schools.
The Association of American Medical Colleges' Committee on Dean's Letters advised in 1988 that the dean's letter should be a letter of evaluation rather than a letter of recommendation. The committee also recommended that the letter contain some form of comparative information to let the residency director know how individual students fared in comparison with their peers. This article reports the results of a 1989 study of the types of agreements between the letter writers and the residency directors of two schools. ⋯ Ordinal ranking from best to worst students revealed a surprisingly high degree of rank-order agreement, but only for 15 of the 16 participating residency directors. Clustering into fixed groups ("top third," etc.) gave high agreement for top students but weaker agreement for the middle and lower groupings. The advantages and disadvantages of these evaluation methods are discussed.
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The authors examined residents' clinical performances in five anesthesiology departments in U. S. teaching hospitals. The data were organized by daily use of the Clinical Anesthesia System of Evaluation, which categorizes and quantifies the narrative comments of faculty. ⋯ Conscientiousness and Composure predicted two-thirds of the variability in critical incidents' scores. Path analysis verified causal relationships between the hypothesized predictors and critical incidents. For the residents studied, inadequate noncognitive performance in some areas was a powerful (p less than .0005) predictor of overall clinical performance and was related to the occurrence of critical incidents.
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Based upon a consideration of data from the literature, a survey, and a problem-solving discussion at a national meeting, the authors suggest the following recommendations concerning the provision to faculty of previous assessment information on students. Students' problems noted by faculty should be shared with the faculty who subsequently teach them. ⋯ Confidentiality must be assured. The rationale for such a policy is discussed.