PURPOSE: Several studies over the past two decades have examined the issue of depression in house staff, but none have attempted to relate it to house staff performance. The ideal study to examine this question would be prospective and longitudinal, using validated psychiatric rating instruments and quality assurance data. Since IRB concerns have thus far precluded such a study, a pilot retrospective survey was developed to obtain preliminary data. METHODS: After IRB approval was obtained for the pilot, the survey instrument was distributed to interns, junior residents, and senior residents in the internal medicine residency program at our institution. Participants were asked whether they had worked with someone they thought was depressed, if they had worked with a colleague whose performance had been affected by depression, and if they had ever been depressed themselves during the residency. RESULTS: 45 members of the house staff (33%) replied to the survey. 34 respondents (76%) believed that they had worked with a depressed colleague during the residency, and 23 respondents (51%) believed that a coworker's performance had been affected by depression. Fifty-one percent of the respondents also reported having experienced depression themselves during their residency. CONCLUSION: Although the sample size is small and these data are only preliminary, depression appears to be prevalent in some internal medicine residency programs. Furthermore, house staff depression may affect patient care. The current pilot study indicates the need for further research in this area. format, the other 2/3rds was interactive. Each workshop included a case with a clinical question, the search strategy, and an article selected to answer the question. While in the small groups participants assessed the validity of the study, interpreted the results and applied the results of the study to the clinical question. We assessed the usefulness of the workshop, materials and effectiveness of the facilitators by asking participants to fill out an evaluation form using 5-point Likert scales to rate the individual items. The participants were asked to rate the workbook and its content, the facilitators, the format of the workshop, the didactic sessions, the interactive sessions, and if they would recommend the workshop. RESULTS: Sixty-one participants completed the evaluation sheets. The median scores for all items were 4 or 5 for all items in both years. The workshop``practice session'' was slightly higher rated in 2000, compared to 1999 (p = 0.047). There were no other significant differences between years. CONCLUSION: A 90 minute workshop can effectively teach the principles and methods for the development of a successful EBM-CDM journal club to faculty members. PURPOSE: Evidence based medicine (EBM) is part of the curriculum of most medical schools and residency training programs in the US. We hypothesized that the concepts and skills may not be integrated into clinical practice because there is little support outside the classroom setting. We surveyed academic internal medicine generalists and subspecialists to assess whether they have different attitudes about evidence based medicine and whether they rate the importance of specific EBM skills differently. METHODS: We surveyed a stratified random sample of academic internists and subspecialists from 11 medical centers in the Chicago area (n=330) in the Spring of 2000. Respondents completed a 39-item self-administered questionnaire, which was piloted and revised for internal consistency prior to use. The three survey questions required respondents to: 1) rate the importance of 9 core skills and 5 EBM skills on a 5-point Likert scale, 2) choose the five most important skills in residency training, and 3) indicate the level to which they agreed or disagreed with 15 attitudinal statements about EBM, also on a 5-point Likert scale. We also collected information on year of graduation from medical school, teaching responsibility, and exposure to a formal course on clinical epidemiology or evidence based medicine. RESULTS: The response rate was 63%. Core medicine skills (clinical reasoning skills, differential diagnosis skills, physical exam skills, interviewing skills, and doctor-patient interaction skills) were scored highest, with all EBM skills rating at least 1 point lower: average core skill score 4.4 vs. average EBM skill score 3.5 (p < 0.001). None of the EBM skills were listed in the five most important skills. EBM skills were rated higher among younger faculty (p = 0.01) and those who had previously taken an EBM course (p = 0.03), but generalists and subspecialists rated the importance of EBM skills similarly (p = 0.56). However, generalists had slightly more positive attitudes about EBM (p = 0.014). Neither year of graduation nor exposure to an EBM course predicted faculty attitudes toward EBM. CONCLUSION: Contrary to our initial hypothesis, generalists and subspecialists differ little in their attitudes about EBM and in their ratings of the importance of EBM skills in residency training. Although both groups rated EBM skills positively, the skills were prioritized much lower than all core skills. Perhaps EBM skills are not routinely reinforced outside formal teaching settings because they are not a high priority among academic faculty-generalists and subspecialists alike. PURPOSE: Few studies have examined the effectiveness of Internet-based medical educational programs for physicians. We wanted to determine whether a skin cancer triage intervention, developed and proved successful in a face-to-face, on-site application, could be effectively delivered over the Internet with the same positive results. METHODS: Physicians were randomly assigned to an Intervention or Control Group. Intervention Group physicians completed modules which included a Pretest, Pretest Scores with Individualized Feedback, Instruction (text and hyperlinks to digitized images of skin lesions), and two Posttests. Control Group physicians completed the Pretest and Posttest I. The program could be completed in 3-4 hours, at participants' convenience. There were 14 outcome measures including diagnosis and evaluation planning for malignant melanoma, basal cell carcinoma, and squamous cell carcinoma. RESULTS: 71 physicians completed the program through Posttest 1, and 46 (27 of 39 in the Intervention Group) completed the entire program. The Intervention Group showed significantly greater improvement than the Control Group in 9 of 14 outcome measures. By Posttest II, Intervention Group improvement was maintained in 5 of the 9 outcomes. CONCLUSION: Our brief, Internet-based, educational intervention with individualized feedback was successful in improving the skin cancer diagnosis and evaluation planning test performance of primary care physicians. The IOM's report on medical errors focused attention on the importance of measuring quality and outcomes. As part of the UME-21 project funded by HRSA, the UCSOM developed a Quality Improvement Curriculum. This abstract examines the impact of student CQI projects on the quality of care delivered at community practices. METHODS: Eighty second year students working in groups of 3-4, initiated a CQI study on Diabetes Mellitus at 23 community-based primary care practices collecting baseline data, implementing a results-specific intervention and re-measuring quality indicators 8 months later. Students attend community-based primary care continuity clinics one-half day/week, year I-III. Students were evaluated using Likert-scale rated attitudinal items as well as open ended questions. RESULTS: 512 charts were abstracted for the baseline sample with 383 charts abstracted postintervention. The number of documented foot and eye exams increased significantly from baseline to remeasurement (51% to 67.8%; p < .001 and 26.4% to 35.5%; p= 0.003, respectively). The mean value for glycohemoglobin dropped from 7.71% at baseline to 7.2% at remeasurment (p=.0001). Analysis of student attitudes revealed acknowledgement of the benefit of outcomes measurement in clinical practice despite frustration with the tedium of the chart abstraction process. Feedback was used to modify curriculum design for future classes. CONCLUSION: Medical student-driven CQI projects can have significant impact on improving the quality of care at the practices in which they participate while introducing them to the process of quality measurement and improvement. Formative input from students should be used to optimize CQI experiences. The use of medical students to lead CQI efforts in private practices may represent an underutilized resource in our efforts to improve the quality of care provided to the public. launched the first program to financially support community-based teaching by enhancing the capitation level of primary care preceptors. We studied the effects of these enhanced capitation payments on preceptors' attitudes towards student training and towards managed care's support of teaching medical students. METHODS: Participants were community-based preceptors who completed a questionnaire consisting of sections on attitudes towards teaching and attitudes towards managed care, given prior to the distribution of enhanced capitation payments (Time 1) and after receiving payments (Time 2). The instrument was given to three groups: AUSHC preceptors receiving enhanced capitation (86/93, 92.5% response rate) and control groups consisting of AUSHC preceptors who chose not to participate in the enhanced capitation program (57/66, 86.4% response rate) and non-AUSHC preceptors (62/68, 91.2% response rate). Responses were scored using a sixpoint Likert scale ranging from Strongly Disagree (1) to Strongly Agree (6). Statistical tests employed included chi-square for differences between the respondent groups, and principal factor analysis and t-tests for differences between Time 1 and Time 2. RESULTS: Factor analysis identified three underlying factors: 1.) Attitudes towards managed care support of physicians, which became less positive, decreased from 3.58 to 3.43 (p = 0.28); 2.) Attitudes regarding the impact of teaching on their practices, remained positive, although slightly decreasing from 4.70 to 4.57 (p=.043); 3.) Attitudes towards their roles as trainers, which was very positive, remained unchanged (5.06 to 5.06, p = .956). No significant difference was found in attitudes when comparing those who received enhanced capitation to the control groups. CONCLUSION: While the enhanced capitation program has provided community-based preceptors with additional financial support, it did not improve preceptors'attitudes concerning managed care's support of their teaching activities. We believe this program is an important first step but more is required. Just as attitudes towards managed care are the result of many factors, initiatives to change those attitudes should be multifactorial.