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ABSTRACT: Empathy is a major component of a satisfactory doctor-patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools.
We designed this study to test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men.
A 20-item empathy scale developed by the authors (Jefferson Scale of Physician Empathy) was completed by 371 third-year medical students (198 men, 173 women).
Associations between empathy scores and ratings of clinical competence in six core clerkships, gender, and performance on objective examinations were studied by using t-test, analysis of variance, chi-square and correlation coefficients.
Both research hypotheses were confirmed. Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations such as the Medical College Admission Test (MCAT), and Steps 1 and 2 of the US Medical Licensing Examinations (USMLE).
Empathy scores are associated with ratings of clinical competence and gender. The operational measure of empathy used in this study provides opportunities to further examine educational and clinical correlates of empathy, as well as stability and changes in empathy at different stages of undergraduate and graduate medical education.
Medical Education 07/2002; 36(6):522-7. · 3.18 Impact Factor
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ABSTRACT: The "Teaching the Teachers" training program was meant to establish standardized ultrasound education programs worldwide, reaching the largest possible number of physicians. The authors performed this study to evaluate the results of this training.
An open-ended test question format (ie, uncued testing) that would evoke responses from physicians in a manner ensuring the highest fidelity with a real clinical setting was selected. An examination was administered at the beginning and the end of the program and then again 6 months later to assess baseline knowledge, changes in knowledge, and knowledge retention, respectively.
Scores on entry and end-of-program examinations were available for 112 participants. The mean entry test score was 35%, and the mean end-of-program examination score was 73%. All changes in scores were statistically significant (P < .001) as determined with paired t tests. Follow-up examinations were available for 27 of the 112 participants at the time of the analysis. On these examinations, mean total test scores increased by nearly 4 percentage points. Although follow-up test scores were available for only 27 participants, these mean test scores were comparable to those reported for the entire group on the end-of-program examination.
The examinations administered at the end of the 3-month program showed marked improvement compared with the baseline assessment. That this improvement remained stable over 6 months indicates the success of the educational process.
Academic Radiology 11/2001; 8(11):1159-67. · 1.69 Impact Factor
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Academic Medicine 11/2001; 76(10 Suppl):S58-61. · 3.52 Impact Factor
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Academic Medicine 11/2001; 76(10 Suppl):S65-7. · 3.52 Impact Factor
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ABSTRACT: A resolution in support of physicians' unionization was recently approved by the American Medical Association's House of Delegates. This study investigated the factors associated with young physicians' approval of unionization.
A survey was mailed to all 1987-1992 Jefferson Medical College graduates (n = 1,272); 835 (66%) responded.
Of the respondents, 43% supported unionization, 31% did not support unionization, and 26% expressed no opinion. Surgeons, medical subspecialists, pediatricians, and hospital-based specialists were more likely to support unionization than were family physicians. Significant predictors of support for unionization were negative views of the changes in the health care system, negative perceptions of the quality of care provided by managed care, the belief that physicians' independence had been impaired by changes in the health care system, and the belief that physicians' personal satisfaction should take precedence over societal needs in determining the future of health care. Support for unionization correlated with physicians' perceptions that mental health patients should be referred to psychiatrists, physician-assisted suicide should be legalized, and the involvement of nurse practitioners in diagnosis and treatment could compromise the quality of care.
Young physicians' support for unionization is a function of frustration with market-driven policies that compromise the quality of care and negatively affect physicians' autonomy and personal satisfaction.
Academic Medicine 11/2001; 76(10):1039-44. · 3.52 Impact Factor
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ABSTRACT: To evaluate the reliability, efficiency, and cost of administering open-ended test questions by computer.
A total of 1,194 students in groups of approximately 30 were tested at the end of a required surgical clerkship from 1993 through 1998. For the academic years 1993--94 and 1994--95, the administration of open-ended test questions by computer was compared experimentally with administration by paper-and-pencil for two years. The paper-and-pencil mode of the test was discontinued in 1995, and the administration of the test by computer was evaluated for all students through 1998. Computerized item analysis of responses was added to the students' post-examination review session in 1996.
There was no significant difference in the performances of 440 students (1993--94 and 1994--95) on the different modes of test administration. Alpha reliability estimates were comparable. Most students preferred the computer administration, which the faculty judged to be efficient and cost-effective. The immediate availability of item-analysis data strengthened the post-examination review sessions.
Routine administration of open-ended test questions by computer is practical, and it enables faculty to provide feedback to students immediately after the examination.
Academic Medicine 09/2001; 76(8):835-9. · 3.52 Impact Factor
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Academic Medicine 08/2001; 76(7):669. · 3.52 Impact Factor
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ABSTRACT: The cost associated with education of residents is of interest from an educational as well as a political perspective. Most studies report a single institution's actual incurred costs, based on traditional cost accounting methods. We quantified the minimum instructional and program-specific administrative costs for residency training in internal medicine.
Using the Accreditation Council for Graduate Medical Education program requirements for internal medicine as minimum standards for teaching and administrative effort, we quantified the minimum instructional and administrative costs for sponsorship of an accredited residency program in internal medicine. We also analyzed the impact of resident complement and program curricular emphasis (outpatient, inpatient, or traditional) on the per-resident cost. The main outcome measure was the minimum annual per-resident cost of instruction and program-specific administration.
Using the assumptions in this model, we estimated the annual cost per resident of implementing the program requirements to be $50,648, $35,477, $28,517, and $26,197 for inpatient intensive residency programs with resident complements of 21, 42, 84, and 126, respectively. For outpatient intensive residency programs of identical resident complements, we estimated the annual per-resident cost to be $58,025, $42,853, $35,894, and $33,574 for similar resident complements. Fixed costs mandated by the program requirements, which did not vary across program size or configuration, were estimated to be $640,737.
There are fixed and variable costs associated with sponsorship of accredited internal medicine residency programs. The minimum cost per resident of education and departmental administration varies inversely with program size within the sizes examined.
Archives of Internal Medicine 04/2001; 161(5):760-6. · 11.46 Impact Factor
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Academic Medicine 11/2000; 75(10 Suppl):S71-3. · 3.52 Impact Factor
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Academic Medicine 11/2000; 75(10 Suppl):S28-30. · 3.52 Impact Factor
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Academic Medicine 11/2000; 75(10 Suppl):S25-7. · 3.52 Impact Factor
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Academic Medicine 11/2000; 75(10 Suppl):S53-5. · 3.52 Impact Factor
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JAMA The Journal of the American Medical Association 10/2000; 284(9):1081-2. · 30.03 Impact Factor
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ABSTRACT: This study examined the relative and incremental importance of multiple predictors of generalist physicians' care of underserved populations.
Survey results from a 1993 national random sample of 2955 allopathic and osteopathic generalist physicians who graduated from medical school in 1983 or 1984 were analyzed.
Four independent predictors of providing care to underserved populations were (1) being a member of an underserved ethnic/minority group, (2) having participated in the National Health Service Corps, (3) having a strong interest in practicing in an underserved area prior to attending medical school, and (4) growing up in an underserved area. Eighty-six percent of physicians with all 4 predictors were providing substantial care to underserved populations, compared with 65% with 3 predictors, 49% with 2 predictors, 34% with 1 predictor, and 22% with no predictors. Sex, family income when growing up, and curricular exposure to underserved populations during medical school were not independently related to caring for the underserved.
A small number of factors appear to be highly predictive of generalist physicians' care for the underserved, and most of these predictive factors can be identified at the time of admission to medical school.
American Journal of Public Health 09/2000; 90(8):1225-8. · 3.93 Impact Factor
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ABSTRACT: This study was designed to investigate gender differences in the USA, in anticipated professional income. Participants were 5314 medical students (3880 men, 1434 women) who entered Jefferson Medical College between 1970 and 1997. The annual peak professional income estimated at the beginning of medical school was the dependent variable and gender within selected time periods was the independent variable. Results showed significant differences between men and women on their anticipated future incomes in different time periods. Women generally expected 23% less income than men. The effect size estimates of the differences were moderately high. The gender gap in income expectations was more pronounced for those who planned to pursue surgery than their counterparts who planned to practice family medicine or pediatrics. A unique feature of this study is that its outcomes could not be confounded by active factors such as experience, working hours, age and productivity. Findings suggest that social learning may contribute to gender gap in anticipated income.
Social Science [?] Medicine 07/2000; 50(11):1665-72. · 2.70 Impact Factor
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ABSTRACT: In 1995, the authors obtained cost, operations, and educational activity data from 98 ambulatory care sites across the United States in which primary care teaching was occurring and compared those data with the corresponding data from 84 ambulatory care sites where no teaching was going on. The teaching sites in the sample were found to have 24-36% higher operating costs than the non-teaching sites. This overall difference in costs is approximately the same difference in costs earlier estimated for university teaching hospitals compared with non-teaching hospitals. These costs are shared by all involved in the ambulatory education process: sponsors, sites, and faculty. In a related finding, the authors discovered that 30-50% of all ambulatory care sites thought not to be involved in education are in fact teaching at a high level of involvement. Further research into not only the costs but the value of education in the clinical setting is encouraged. The authors also hope that the publication of this report will encourage accrediting bodies and professional organizations to improve the information available about ambulatory care training in general.
Academic Medicine 06/2000; 75(5):419-25. · 3.52 Impact Factor
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ABSTRACT: Accurate data on the number of generalist physicians are needed to monitor the physician workforce and to plan for future requirements in the changing health care system. This study assessed the relationship between two frequently used definitions of a generalist physician: completion of graduate medical education (GME) in only a generalist discipline and physician's self-report of practicing as a generalist. Data for 4,808 physician graduates from six Pennsylvania medical schools from 1986 to 1991 were analyzed using information from the GME tracking census of the Association of American Medical Colleges and the Physician Masterfile of the American Medical Association. Of 1,291 physicians trained in a generalist discipline, 1,205 (93%) reported practicing as generalists. Conversely, of the 3,517 not trained in a generalist discipline, 3,358 (95%) were not practicing as generalists. These results indicate GME training is a valid predictor of self-reported practice and provide baseline data to monitor future changes.
Evaluation & the Health Professions 01/2000; 22(4):497-502. · 1.23 Impact Factor
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Academic Medicine 11/1999; 74(10 Suppl):S102-4. · 3.52 Impact Factor
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Academic Medicine 11/1999; 74(10 Suppl):S78-80. · 3.52 Impact Factor
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ABSTRACT: To examine changing levels of interest in primary care as related to clinical experiences during medical school, and to other variables.
A total of 1,911 (74%) allopathic medical school graduates responded to a national survey in early 1993. Respondents' reported changes of interest in primary care during medical school were cross-tabulated with their clinical experiences in medical school, their demographics, their interests prior to medical school, and their future practice plans.
Increased interest in primary care during medical school was strongly associated with the electives taken in primary care. This positive change of interest in primary care was found to be associated with interest prior to medical school and with primary care career plans.
Schools wishing to graduate more students who enter primary care specialties may want to raise the number of primary care elective courses to increase students' interests, and to help them choose to enter and remain in primary care specialties.
Academic Medicine 10/1999; 74(9):1011-5. · 3.52 Impact Factor
