D.E. Bonds 1 , R. Watkins 1 , J.C. Mychaleckyj 1 ; 1 Wake Forest University, Winston-Salem, NC PURPOSE: Previous studies have found that Internal Medicine faculty and residents rate their ability in ambulatory care procedures as poor. Our objective was to assess faculty and residents ability in those skills related to Women's Health, and whether that ability varies by gender or status (resident vs faculty). METHODS: A descriptive survey was administered to all Internal Medicine residents and teaching faculty at one academic medical center. Respondants were asked to rate their ability to perform 5 ambulatory skills (breast exam, pelvic exam, wet mount/KOH, pap smear, endometrial biopsy) and comfort in obtaining 4 areas of history/counseling (sexual activity history, domestic violence history, preconception counseling, contraceptive counseling). A 4point Likart scale was used. RESULTS: 88 Internists completed the survey: 91% of residents (72/79) and 80% of faculty (16/20). Women comprised 32% (32% residents, 31% faculty). Greater than 70% felt able to perform all physical exam and procedural skills except endometrial biopsy (0% able). Conversely, less than 40% rated their comfort level as high for domestic violence history, and areas of counseling. Women rated their ability higher than men, and faculty higher than residents. See table 1 for full results (* indicates p < =0.05). CONCLUSION: Faculty and residents rated their ability high for exam and procedural skills, but most felt uncomfortable in obtaining history or performing counseling. Women rated their skill level higher, as did faculty. Both faculty and residents need additional training in ambulatory skills related to women's health. To assess the relative degrees to which a variety of factors are perceived to contribute positively and negatively towards motivating internal medicine residents to improve their physical examination skills. METHODS: In May 2000, forty G1 internal medicine residents at the Mayo Clinic completed an objective, structured clinical examination (OSCE). Immediately following this exercise, they were anonymously surveyed regarding the degree to which certain factors tended to either increase or diminish their motivation for improving their skills in physical examination. Twelve potential motivators and thirteen potential barriers were ranked on a Likert scale from one to seven. RESULTS: Those factors ranked as the strongest motivators for improvement had to do with the role of the physical examination (PE) in patient care decisions (mean score = 5.9), the regret of missed findings in the past (5.9), and the perceived contribution of strong PE skills to one's overall excellence as a clinician (6.0) or teacher (5.3). The need to enhance one's performance on formal measures such as the OSCE (3.6) or to fulfill the expectations of faculty (4.6) or peers (4.0) on rounds were rated as weaker motivators. Perceived barriers to improvement included lack of time to study (5.2) or apply (5.1) the methods of PE and a lack of faculty emphasis on the importance of PE (4.8). Although the sense of exam findings being eclipsed by test results in making clinical decisions was rated as a moderately strong demotivator (5.1), other factors designed to look for overall``PE nihilism'' were ranked as only weak hindrances to improvement (2.7). Likewise, a sense of discouragement over one's past performance and future prospects for improvement seemed to be a minor barrier (3.4) , as did reliance on a perceived supervisorỳ`s afety net'' (2.0). CONCLUSION: Internal medicine residents in their first year of training seem to be most strongly motivated to improve their PE skills by factors which relate to their desire to improve the quality of patient care, to avoid regret, and to build personal confidence as an excellent clinician and teacher. The most significant demotivators are lack of time to study and apply the methods, and lack of faculty emphasis on the importance of these skills. The perception of test results eclipsing the contribution of the physical exam to clinical decisions also seems to demotivate at some level, and educational strategies which emphasize those situations wherein the exam makes an indispensable contribution to patient care may help to overcome this potential barrier. Few studies, however, explore fellows' training expectations or their satisfaction with the program they select. We sought to evaluate these factors and identify areas of training that lead to a productive and satisfying fellowship experience. METHODS: We developed a 43-item questionnaire that addressed fellows' initial training expectations, satisfaction with the quantity and perceived quality of training (teaching and research), availability of mentors, scholarly productivity (publications, grants) and anticipated career track. Question format included best answer and Likert scales. Directors of the 37 active fellowship programs listed in the 2000 SGIM Fellowship directory were contacted by e-mail and asked to forward our web-based survey to current fellows. To calculate an accurate response rate while maintaining respondent anonymity, each fellow used a program-specific code to initiate the survey. RESULTS: Forty-three percent (65/152) of fellows completed the survey, with at least 1 respondent in 65% (24/37) of the programs. Nearly three-quarters (74%) anticipated careers as clinician-investigators. Eighty-two percent had high or very high initial expectations for research training, 26% for teaching and 20% for learning leadership skills. The availability of mentors (95%), program flexibility (94%) and protected time for research (91%) were rated as the most important factors in fellowship training. Most fellows were satisfied or very satisfied with the actual availability of mentors (80%), program flexibility (85%) and protected research time (88%). Over 80% agreed that their expectations had been met for both the quantity and quality of research opportunities, while 63% reported this for the quantity and 40% for quality of teaching opportunities. The availability of mentors and the perceived quality of research opportunities were significantly correlated with fellowship scholarly productivity, 0.507 and 0.539 respectively (p < .001). CONCLUSION: This study suggests that the majority of GIM fellows enter training with the expectation for advanced research skills and are satisfied with most aspects of their experience. These data highlight the important correlation between mentoring, high quality research opportunities and scholarly productivity during fellowship. That relatively few fellows are satisfied with the quality of available teaching opportunities is concerning and deserves further exploration. METHODS: We designed a 10-page survey to determine the extent of faculty development (FD) activities that focused on``improving the teaching/educational skills'' of faculty. For those hospitals with ongoing activities we asked about the subjects covered, the methods of teaching, the formats offered, and the evaluation of the programs. In April 2000, we mailed the survey to Department of Medicine chairmen at the 390 teaching hospitals with internal medicine residency training programs in the U.S. We classified teaching hospitals with membership in the Association of Professors of Medicine as university hospitals (N=114), and those without membership as non-university. We performed descriptive analyses of hospitals with and without ongoing FD, and used chi2 to detect differences in categorical variables and t-tests for differences in continuous variables. RESULTS: Three hospitals responded that their training programs had closed. Of the remaining 387 hospitals, 279 responded for a response rate of 72%. Only 39% of teaching hospitals have ongoing FD, including 48% of university and 34% of non-university hospitals (p=.007). An additional 34% have occasional FD; 27% have no FD activities. At the hospitals with ongoing FD activities (N=109), an average of 10 content areas are covered, with university hospitals including more than non-university hospitals (11 vs. 9, p=.036). The most common content areas are general teaching principles (90%), giving feedback (88%), outpatient precepting (72%) and evaluation of learners (72%). FD is taught most commonly in small group sessions, with 65% of hospitals using them frequently/always, and in lectures, with 50% using them frequently/always. The most common format for FD is a 1/2 day workshop (78%), but 21% offer courses lasting more than a month. Compared to university hospitals, non-university hospitals are more likely to offer 1/2 day workshops only (p=.008), or courses < 7 days (p=.013), and less likely to offer longer courses (p=.006). Evaluation of FD programs is limited to forms filled out by participants at the end of the program. Most programs had trained: < 50% of hospital-based and < 25% of community-based faculty; < 50% of general internal medicine faculty and < 25% of subspecialist faculty. 2/3 of hospitals with FD, but only 37% of hospitals with no FD, arrange for faculty to go off-site for FD.