PREDICTORS OF EFFECTIVE PHYSICAL DIAGNOSIS TEACHING. K. Barnard 1 , D. Lescisin 1 , N. Armistead 1 , D. Elnicki 1 ; 1 University of Pittsburgh, Pittsburgh, PA PURPOSE: Interns play an important role in the teaching of medical students. We sought to identify demographic characteristics and teaching behaviors that predict effective teaching of physical diagnosis skills. METHODS: Self-administered surveys were completed by third year students at the end of their internal medicine clerkship at two medical schools from 7/00-11/00. Questions included demographic characteristics of interns and students, and occurrence of teaching behaviors, such as observation and feedback, reviewing cases, and establishing a comfortable learning climate. We also asked students to assess to what degree the intern contributed to their learning physical diagnosis skills (diagnosing heart murmurs, distinguishing pulmonary consolidation from pleural effusion, detecting hepatomegaly, examining the thyroid gland, detecting a joint effusion and lymphadenopathy). These items were selected from the CDIM-SGIM curriculum, and were combined to form a grouped physical diagnosis variable. A forward, step-wise linear regression model was built to determine which of the independent variables predicted effective physical diagnosis teaching. Adjusted p-values are shown here. RESULTS: A total of 70 students were surveyed (95% response rate). The teaching behavior,`m aking helpful suggestions to improve performance'', was most important in predicting effective teaching of physical diagnosis, as measured by the grouped variable, (p = 0.006). The addition of two other variables,``corrected mistakes without making you feel belittled'', and intern gender created a model with R2= 0.35. When the physical diagnosis variables were analyzed separately, the teaching behaviors,``observed you elicit physical examination findings'' and,``demonstrated a breadth of knowledge in internal medicine'' were important in predicting the ability to distinguish pleural effusions (p = 0.087 and 0.075 respectively). Observing students eliciting findings was important to examination of the thyroid gland (p = 0.07). The models for the individual physical examination skills explained 23%-59% of variances. CONCLUSION: Teaching behaviors involving giving feedback and female gender were most important to students learning physical diagnosis skills from interns. Other teaching behaviors were important for individual physical examination skills. The reasons for the gender differences remain unclear. PURPOSE: In order to prepare residents for primary care practice an understanding of what factors influence their satisfaction with the outpatient experience is necessary. However, few studies have addressed determinants of resident satisfaction in their continuity clinics. This study was conducted to determine these factors. METHODS: Over a 2-month period, resident satisfaction was assessed through a selfadministered questionnaire completed by each internal medicine resident in their outpatient continuity clinic. All 68 residents working in the clinic completed the questionnaire. The number of questionnaires completed by each resident ranged from 1 to 60 with a median of 23. The questionnaire was comprised of three 5-point Likert scale items that assessed resident satisfaction with each patient encounter. Resident satisfaction was defined as the mean of the 3 items. The resident satisfaction items had a Cronbach's alpha of 0.88. Other items assessed by the questionnaire included contextual aspects of the clinic, diagnoses of the patients, continuity, and demographic data. RESULTS: Overall, the majority of clinic visits were satisfying to residents. The mean satisfaction score of all resident clinic visits was 4.02 (5-point scale) with a standard deviation of 0.91. However, patient diagnosis had a significant impact on resident satisfaction. The mean resident satisfaction score for patients diagnosed with general medical problems was 4.30. The mean resident satisfaction score for patients diagnosed with pain complaints was 3.58 (p < 0.0001) and for psychiatric disorders it was 3.27 (p < 0.0001). Clinic visits with patients diagnosed with pain complaints or psychiatric disorders were more satisfying to residents if the patients were male rather than female (p < 0.05). 1st year residents were less satisfied with patients diagnosed with pain complaints or psychiatric disorders than 2nd and 3rd year residents (p < 0.05). On the other hand, 1st year residents found visits with patients diagnosed with general medical problems more satisfying than 2nd and 3rd year residents (p < 0.05). A number of factors were not associated with resident satisfaction including resident gender, rotation, and call status. CONCLUSION: Although resident satisfaction with patient encounters in the outpatient clinic is high, resident satisfaction is influenced by the patient diagnosis. Seeing patients with pain or psychiatric diagnoses is associated with decreased resident satisfaction in their continuity clinic. However, this appears to be influenced by the experience level of the resident. Future research can explore whether early resident training in the treatment of pain and psychiatric conditions may increase resident satisfaction with such patients. PURPOSE: Approximately 25% of Americans are functionally illiterate and low literacy has been associated with poorer physical health, psychological health, and higher health care cost. This study was conducted to see if residents could identify patients with potential literacy problems based solely on interactions with patients during a clinic visit. We hypothesized residents will overestimate patients' literacy abilities and not identify many patients at risk for potential literacy problems. METHODS: Residents completed a questionnaire measuring a number of constructs regarding continuity clinic in general, and their perception of their continuity patients' literacy. The residents were asked,``Do you feel this patient has a literacy problem?'' Patients in continuity clinic were given the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), a new instrument to quickly screen for potential literacy problems. The REALM-R has been previously correlated with the Wide Range Achievement Test-Revised (WRAT-R) and the Rapid Estimate of Adult Literacy in Medicine (REALM), two well-validated instruments but impractical for large scale screening in a busy clinic. The REALM-R asks patients to read a series of eight medical words and a correct response is given for each correct pronunciation. A score of six or less was used to identify patients with a potential literacy problem. Data were available from 182 patients who completed the REALM-R and whose residents completed the literacy question. RESULTS: Patients ranged in age from 17 to 93, and 85% were Caucasian. Scores on the REALM-R ranged from 0 to 8 with a mean of 6.8 and S.D. of 2.1. Twenty-three percent of patients read at the eighth grade level or less according to the WRAT-R. Despite these baseline characteristics, residents believed only 10% (18) of patients had a literacy problem based on their clinical interactions. Residents perceived 90% (164) of patients to have no literacy problem, but 36% (59) of these patients scored 6 or less on the REALM-R. Conversely, residents identified three patients as having a literacy problem whom scored higher than six on the REALM-R, while the other 15 all scored six or less. CONCLUSION: Residents perceived a significant number of patients to have no literacy problem, although these patients scored poorly on the REALM-R. Residents incorrectly identified only a few patients. Residents' overestimation of patients' literacy is concerning given that many patients will hide literacy problems from physicians and the poor health outcomes associated with poor literacy. A brief screening instrument like the REALM-R may help clinicians identify patients in whom literacy may complicate their health care. METHODS: This data is derived from the intake questionnaire for participants in the PSPA study. We obtained names and addresses from the AAMC roster for faculty that entered academic medicine as Assistant Professor June through December of 1995. In 2000, 183 faculty members from 35 different states volunteered to participate. Participants indicated they were clinician-educators (CE) or clinician-investigators (CI). If participants indicated``other'' or`c linician'', we assigned them a priori to one of the two former categories based upon their percent effort allotted to various work activities. RESULTS: Participants had a mean age of 40 years, and had been working at their current position for 4.7 years. 63% of the faculty were clinician-educators (CE) and 37% were clinician-investigators (CI). More CI's than CE's were minorities (30% vs. 14%, p < .05), but there was no significant difference in gender (35% female). Whereas 98% of CI's reported a publication expectation to be promoted, 25% of the CE's reported no such expectation (p < .001). Significantly more CI's had career mentors available than CE's (68% vs. 32%, p < .001), and 92% of CE's for whom they are not available indicated they would like one. 79% of CI's indicated >10% protected scholarly work time, compared to only 35% of CE's (p < .001). 53% of CI's vs 32% of CE's (p < .01) meet more often than yearly with their chief/ chair for performance review, and more CI's have seen written promotion guidelines (72% vs. 51%, p < .01). CE's and CI's assigned similar importance to clinical research, written scholarship, and reputation (top 3 out of 11 items in importance for both groups) as activities leading to their promotion. The top 3 important activities for CE's according to promotion committee chairs in our previous study (teaching skills, clinical skills, and mentoring), were ranked 4th, 10th, and 8th by CE's in this study. Both CE's and CI's agreed that CI's more likely get promoted (82% vs. 79%). CONCLUSION: CE's indicated fewer performance reviews with their chair/chief, fewer mentors, and less knowledge of written promotion guidelines than their CI colleagues. Although university promotion chairs have indicated that teaching and clinical skills are most important in the promotion of CE's, CE's believe research and written scholarship are most critical to their promotion. PURPOSE: The purpose of this study was to identify residents' perceptions of the socioculturally and linguistically based barriers they face in caring for a diverse patient population. We also attempted to determine whether, and in what ways, a required crosscultural curriculum helped them deal with these barriers. METHODS: We conducted structured interviews with the entire intern class of an urban academic internal medicine residency program (n=40). These were carried out with the stated goal of identifying general barriers to quality care for their patient population. Interviews were performed within six months of the completion of an eight-hour, case-based, cross-cultural curriculum. Residents were not aware of any connection between the research assistant who conducted the interview and the primary researchers who taught the curriculum. Probes for the interview focused on: general barriers to care, sociocultural and linguistic barriers to care, if and how they had been prepared to deal with these barriers and the type of training they had received, and whether the cross-cultural curriculum had helped them and affected their attitude towards these issues. Interviews were recorded, transcribed, and coded by two independent outside researchers experienced in qualitative analysis. RESULTS: Several barriers to delivering care were identified: