Education for Clinical Medicine: An Annotated Bibliography of Recent Literature
Authors: James B. Reuler, David A. Nardone, Diane L. Elliot, Donald E. Girard
Journal: Annals of Internal Medicine (1982)

The Literature of Medicine1 October 1982Education for Clinical Medicine: An Annotated Bibliography of Recent LiteratureJAMES B. REULER, M.D., DAVID A. NARDONE, M.D., DIANE L. ELLIOT, M.D., DONALD E. GIRARD, M.D.JAMES B. REULER, M.D.Search for more papers by this author, DAVID A. NARDONE, M.D.Search for more papers by this author, DIANE L. ELLIOT, M.D.Search for more papers by this author, DONALD E. GIRARD, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-97-4-624 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThis bibliography was born from a perceived need for a current and concise reference library for internists involved in undergraduate and postgraduate clinical education. Although in the past undergraduate medical education in the clinical areas was centered in university, county, or government hospital settings, the increase in the number of university-affiliated community hospitals offering core and elective clerkship programs, combined with the recruitment of community-based physicians for patient evaluation courses and preceptorship electives, have dramatically increased the number of practicing physicians involved in medical education. Similarly, at the postgraduate training level, community hospital affiliations and the proliferation of free-standing internal...General Medical Student Education INTRODUCTION TO CLINICAL MEDICINE CLERKSHIP EVALUATION House Officer Education GENERAL PRIMARY CARE PROGRAMS EDUCATION IN THE CLINIC SETTING EVALUATION The Clinician-Teacher1. . Annual Conference on Research in Medical Education. Summary of original research papers and symposia presented at the annual Research in Medical Education (RIME) Conference. The new edition is available yearly from the Association of American Medical Colleges, Washington, D.C. Citations are listed in Index Medicus (Annu Conf Res Med Educ). Google Scholar2. . Graduate medical education: proposals for the eighties. J Med Educ. 1981;56(3 Pt 2):1-145. Report of the Association of American Medical Colleges Task Force on Graduate Medical Education addresses the quality of graduate medical education, transition between undergraduate and graduate medical education, accreditation, specialty distribution and training, and financing of graduate medical education. MedlineGoogle Scholar3. . 81st annual report on medical education in the U.S. 1980-1981. JAMA. 1981;246:2901-85. Annual compendium of recent events of special interest to medical education and data on all levels of medical education. Handy reference containing many tables and statistics. Published as last issue of each calendar year in JAMA. Google Scholar4. BARROWSTAMBLYN HR. Problem-Based Learning—An Approach to Medical Education. New York: Springer Publishing Company; 1980. The problem-based/student-centered learning model, as opposed to the subject-based/teacher-centered model, is detailed in the context of the process of clinical reasoning. Medical education is presented as an applied science. Google Scholar5. BUTLERBENTLEYKNAPP PJR. Today's teaching hospitals: old sterotypes and new realities. Ann Intern Med. 1980;93:614-8. The evolution of the teaching hospital over the past 2 decades is reviewed. Distinguishing characteristics, operating environments, and costs of this large spectrum of institutions are discussed, including perspectives of third-party carriers and regulators. LinkGoogle Scholar6. CLUFF L. Medical schools, clinical faculty, and community physicians. JAMA. 1982;247:200-2. A review of the evolution of the increasing reliance of medical schools on community hospital resources and the tensions that have ensued. Proposals for strengthening these important affiliations are presented. CrossrefMedlineGoogle Scholar7. COOMBS R. Mastering Medicine—Professional Socialization in Medical School. New York: The Free Press; 1978. Based on data from a decade of research, this text explores the process of professional socialization through an intensive longitudinal analysis of an entire class of medical students. Google Scholar8. ENGEL G. Care and feeding of the medical student: the foundation for professional competence. JAMA. 1971;215:1135-41. Noting that medical schools fail to prepare students to understand patients and the human problems of illness, Dr. Engel calls for a reordering of priorities and proposes means to correct these deficiencies. CrossrefMedlineGoogle Scholar9. KNAPPBUTLER RP. Financing graduate medical education. N Engl J Med. 1979;301:749-55. This article examines the impact of increasing pressure to reduce hospital expenditures on graduate medical education, which has been financed to a large degree by hospital revenues. Financing plans for the future and their inherent problems are discussed. CrossrefMedlineGoogle Scholar10. REGELSON W. The weakening of the Oslerian tradition: the changing emphasis in departments of medicine. JAMA. 1978;239:317-9. Commentary articulating the circumstances surrounding the commonly heard lament that "role-model" clinicians are disappearing from faculties, leading to the death of a system of teaching of medicine as a "healing art." CrossrefMedlineGoogle Scholar11. RIPPEY R. The Evaluation of Teaching in Medical Schools. New York: Springer Publishing Company; 1981. Beginning with the assumptions that teaching makes a difference, teachers can change, and evaluation is possible, the author builds a comprehensive model of evaluation. Particularly useful for educational leaders responsible for faculty evaluation programs. Google Scholar12. ROGERS D. American Medicine: Challenges for the 1980's. Cambridge, Massachusetts: Ballinger Publishing Co.; 1978. Written by the president of The Robert Wood Johnson Foundation, this text reviews the status of medical care in America, the academic medical center, and medical education, and proposes an agenda for the future. Google Scholar13. SAMPHTEMPLETON TB. Evaluation in Medical Education: Past, Present, Future. Cambridge, Massachusetts: Ballinger Publishing Co.; 1979. This text provides an historical overview of the issues surrounding professional accountability and evaluation of competence. Chapters on educational institutions, governmental agencies, and independent assessment programs are included. Google Scholar14. SCHMIDTZIEVED'LUGOFF CPB. A practice plan in a municipal teaching hospital: a model for the funding of clinical faculty. N Engl J Med. 1981;304:263-9. The increasing necessity of private practice-generated income has inherent implications for undergraduate and graduate education. This practice-plan program was able to obviate some of these problems and support the clinical, teaching, and research goals of the faculty. CrossrefMedlineGoogle Scholar15. SHAPIROLOWENSTEIN EL, eds. Becoming a Physician: Development of Values and Attitudes in Medicine. Cambridge, Massachusetts: Ballinger Publishing Co.; 1979. A multi-authored text reviewing the literature on professional role development, career decisions, and practice patterns. Google Scholar16. STARPOLIWALTZ CC. Developing and Evaluating Educational Programs for Health Care Providers. Philadelphia: F.A. Davis Company; 1978. A good sourcebook for those involved in planning, implementing, and evaluating educational programs. Contains discussions of fundamental concepts in educational psychology. Google Scholar17. BENBASSATSCHIFFMANN JA. An approach to teaching the introduction to clinical medicine. Ann Intern Med. 1976;84:477-81. Based on research identifying the characteristics of diagnostic reasoning of expert physicians, a program was developed to teach preclinical students to use similar diagnostic strategies. The objectives and elements of the course are described. LinkGoogle Scholar18. HOLZMANSINGLETONHOLMESMAATSCH GDTJ. Initial pelvic examination instruction: the effectiveness of three contemporary approaches. Am J Obstet Gynecol. 1977;129:124-9. Patient-instructor feedback during pelvic examination instruction was superior to traditional methods of gynecologist supervision in development of students' interpersonal and psychomotor skills but not cognitive skills. CrossrefMedlineGoogle Scholar19. MORGANENGELLURIA WGM. The general clerkship: a course designed to teach the clinical approach to the patient. J Med Educ. 1972;47: 556-63. A general clerkship in patient evaluation is conducted in a separate block of time between the basic science and clerkship years so that other courses will not interfere with these learning objectives. MedlineGoogle Scholar20. NARDONEREULERGIRARD DJD. Teaching history taking: where are we? Yale J Biol Med. 1980;53:233-50. This paper reviews the literature on concepts in taking a medical history. The focus is on what subjects should be taught and what methods to use. An attempt is made to describe graduated levels of clinical competency based on training. MedlineGoogle Scholar21. SAJIDLIPSONTELDER ALT. A simulation laboratory for medical education. J Med Educ. 1975;50:970-5. Simulations using three-dimensional replicas, electronic devices, computer-assisted encounters, and video interactions provide supplemental learning opportunities in patient evaluation. These preparatory tools are best used before encounters with patients and for feedback. MedlineGoogle Scholar22. STILLMANRUGGILLRUTALASABERS PJPP. Patient instructors as teachers and evaluators. J Med Educ. 1980;55:186-93. Use of trained subjects with stable physical findings can provide feedback and objective evaluation of a trainee's skills in physical diagnosis. Patient instructors substantially decrease faculty time commitment. MedlineGoogle Scholar23. TUTEUR P. Introduction to clinical medicine: description of a course. J Med Educ. 1979;54:112-4. Description of a course that includes multiple instructors, close supervision, low student-faculty ratio, liberal use of audio-visual aids, and well defined objectives. Data gathering in the history and physical examination and communication skills are stressed. MedlineGoogle Scholar24. BLACKWELL B. Medical education: old stresses and new directions. Pharos. 1977;40:26-30. A concise overview of the ongoing dilemma faced by medical schools in their attempts to recruit students from among qualified applicants and better approach the stress-related problems that have a major impact on student survival. Google Scholar25. FOLEYSMILANSKYYONKE RJA. Teacher-student interaction in a medical clerkship. J Med Educ. 1979;54:622-6. Student involvement in multiple teaching settings was passive and required little cognitive interaction with supervisors. It appears that the clinician-teacher does not effectively facilitate active student participation in the problem-solving process. MedlineGoogle Scholar26. FRIEDMANSTRITTERTALBERT CFL. A systematic comparison of teaching hospital and remote-site clinical education. J Med Educ. 1978;53:565-73. The authors describe a method for determining how medical students spend their time at different hospital sites during an obstetrics and gynecology clerkship. More appropriate assignment of students is a potential advantage. MedlineGoogle Scholar27. GIRARD D. On becoming a clinician. Forum on Medicine. 1980;3:760-800. A commentary on the challenge for the medical student to become a mature physician. Google Scholar28. GJERDE C. 'Curriculum mapping': objectives, instruction, and evaluation. J Med Educ. 1981;56:316-23. This is a provocative study showing that, at the end of 3 years, there was very little congruence among course objectives, instruction, and evaluation. Curriculum objectives may have academic short half-lives. Frequent review is recommended. MedlineGoogle Scholar29. GROVERSMITH PD. Academic anxiety, locus of control, and achievement in medical school. J Med Educ. 1981;56:727-36. For medical students, factors predicting academic failure transcend previous achievement. These authors report that academic anxiety, stress-coping mechanisms, and degrees to which external or internal factors influence behavior are instrumental in predicting academic success. MedlineGoogle Scholar30. MARKUSMASTSOLER JTN. Written versus oral feedback: their effect on learning in an internal medicine clerkship. Annu Conf Res Med Educ. 1979;18:239-44. Although feedback improved performance on retesting of specific concepts, there was no overall increased learning in a particular content area. There was no advantage of one type of feedback versus the other. MedlineGoogle Scholar31. ROBINSON D. The medical-student spouse syndrome: grief reactions in the clinical years. Am J Psychiatry. 1978;135:972-4. The demands of the clinical service for medical students also impact adversely on spouses and significant others. They suffer from partial loss of a loved one and react with protest, despair, and detachment. CrossrefMedlineGoogle Scholar32. BARRO A. Survey and evaluation approaches to physician performance measurement. J Med Educ. 1973;48(suppl):1051-93. Exhaustive investigation of dimensions of physician performance and how these dimensions have been measured. Google Scholar33. BARROWSTAMBLYN HR. Self-assessment units. J Med Educ. 1976;51:334-6. MedlineGoogle Scholar34. HARDENGLEESON RF. Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ. 1979;13:41-54. These articles exemplify innovative methods of evaluation. In the first article, simulated patients and videotaping allowed for student self-assessment and immediate feedback. The second article discusses the rationale and practicalities of implementing a multifaceted practical exam of clinical competence. Neither method has gained widespread use, but both suggest areas for further investigation. CrossrefMedlineGoogle Scholar35. DAVIDGEDAVISHULL AWA. A system for the evaluation of medical students' clinical competence. J Med Educ. 1980;55:65-7. MedlineGoogle Scholar36. DIELMANHULLDAVIS TAW. Psychometric properties of clinical performance ratings. Eval Health Prof. 1980;3:103-17. Despite the pitfalls in faculty assessment, examples of ways to improve evaluation are available. The clinical evaluation form developed at the University of Michigan contains 15 dimensions for assessment, each with four delineated levels of performance. The form provides expectations for students and enhances accuracy of assessment. The second article contains a reproduction of the form and statistical evaluation of its use. CrossrefGoogle Scholar37. IRBYFANTELMILAMSCHWARTZ DJSM. Legal guidelines for evaluating and dismissing medical students. N Engl J Med. 1981;304:180-4. Courts have upheld the medical school's qualifications for deciding academic standards. In addition, academic dismissal must be accompanied by an opportunity for review and due process. Disciplinary dismissal requires stricter substantiation of facts and procedural rules. Guidelines for both types of dismissal are discussed. CrossrefMedlineGoogle Scholar38. KAPP M. Legal issues in faculty evaluation of student clinical performance. J Med Educ. 1981;56:559-64. Clinical faculty may be reluctant to candidly evaluate students due to fear of legal reprisal. However, the law permits and encourages honest assessment of trainee performance. Suggested guidelines for due process in evaluation are presented. MedlineGoogle Scholar39. LEVINEMCGUIRENATTRESS HCL. The validity of multiple choice achievement tests as a measure of competence in medicine. Am Educ Res J. 1970;7:69-82. The multiple choice examination is reliable and easy to administer and score. Items assess cued recall of facts rather than higher level mental processes. For valid and reliable overall assessment, they must be supplemented with other methods of assessment. CrossrefGoogle Scholar40. LlTTLEFIELDHARRINGTONANTHRACITEGARMAN JJNR. A description and four-year analysis of a clinical clerkship evaluation system. J Med Educ. 1981;56:334-40. MedlineGoogle Scholar41. O'DONOHUEWERGIN WJ. Evaluation of medical students during a clinical clerkship in internal medicine. J Med Educ. 1978;53:55-8. MedlineGoogle Scholar42. WILLOUGHBYGAMMONJONAS TLH. Correlates of clinical performance during medical school. J Med Educ. 1979;54:453-60. Correlations among the different methods of assessing competence are low; these three reports confirm the need for a multifaceted evaluation of students. Multiple choice exams are reliable but limited in their areas of assessment. Oral exams are dependable if evaluators are trained, but less valid due to sampling errors. Evaluations by faculty, although less dependable, provide important information on ward performance and noncognitive skills. Their dependability is enhanced by improving the evaluation form, educating faculty on its use, and increasing the number of evaluators. MedlineGoogle Scholar43. MORGANIRBY MD. Evaluating Clinical Competence in the Health Professions. St. Louis: The C. V. Mosby Company: 1978. Although this text does not specifically address medical education, it contains practical information on selection of evaluation instruments, and implementation and management of evaluation systems. Google Scholar44. NEWBLEELMSLIEBAXTER DRA. A problem-based criterion-referenced examination of clinical competence. J Med Educ. 1978;53:720-6. An innovative test of clinical competence is described that uses patient problem blueprints and includes both written and interactive sections. Feedback from students indicated that this method described their competence more accurately than traditional clinical exams. MedlineGoogle Scholar45. QUARRICKSLOOP EE. A method for identifying the criteria of good performance in a medical clerkship program. J Med Educ. 1972;47:188-97. The evaluation of students among departments within a medical school is not uniform, and attributes of a "good" student differ. An interesting finding was that the level of involvement was as important an attribute as medical knowledge in overall assessment. MedlineGoogle Scholar46. WIGTON R. The effects of student personal characteristics on the evaluation of clinical performance. J Med Educ. 1980;55:423-7. A revealing study that points out that faculty members do not share uniform criteria for assessment. In addition, their evaluations are influenced more by the student's personal characteristics than the content or organization of data conveyed. MedlineGoogle Scholar47. BARONDESS J. The training of the internist: with some messages from practice. Ann Intern Med. 1979;90:412-417. The author argues that clinical sophistication should be the hallmark of the internist and questions the appropriateness of certain "ambulatory care" experiences in training programs. This article stimulated much controversy in letters to the editor. LinkGoogle Scholar48. BECKER E. Graduate medical evaluation: present and future. Trans Am Clin Climatol Assoc. 1980;92:152-65. A succinct and lucid review of the complex structure involved in accreditation of residency training programs. Recently proposed changes in this matrix and their implications are discussed. Google Scholar49. BECKERWORTMANNSILVA GRJ. Computerized house officer schedules at the University of Michigan. J Med Educ. 1982;57:308-15. The computer program produces schedules that conform more closely to house officer preferences than those devised manually. Time and money are saved, flexibility is maintained, and educational and staffing requirements are more easily delineated. MedlineGoogle Scholar50. . Attributes of the general internist and recommendations for training. Ann Intern Med. 1977;86:472-3. Statement from the American Board of Internal Medicine on guidelines for training programs. LinkGoogle Scholar51. DALEWALLACECLARKROCKEYFEATHERSTONEPETERSDORF DJHPHR. Restructuring an internal medicine residency program to meet regional and national needs for general internists. Am J Med. 1981;70:1085-90. A detailed description and analysis of a restructured university-based residency program that uses community and regional resources indicates that the goal of placing general internists into smaller communities was accomplished. CrossrefMedlineGoogle Scholar52. EYANSONBRANDT SK. Effect of a rheumatology elective on house officers' evaluation of rheumatoid arthritis. Arch Intern Med. 1980;140:1449-52. Chart audit study suggests that a rheumatology elective improves house officer evaluation of rheumatoid arthritis and that the benefits endure. CrossrefMedlineGoogle Scholar53. FREYENGERBRETSENOLSONCARMICHAEL JBJL. Resident participation in residency programs. J Med Educ. 1975;50:765-72. Description of a residency review committee that facilitates input by house officers and increases their responsibility for the educational program. MedlineGoogle Scholar54. GIRARDSACKREULERCHANGNARDONE DRJMD. Survival of the medical internship. Forum on Medicine. 1980;3:460-3. The internship is a developmental crisis through which students become responsible physicians. A predictable chronology of emotional stages experienced by most interns is described and the importance of recognition of them by program directors is emphasized. MedlineGoogle Scholar55. JEWETTGREENBERGGOLDBERG LLR. Teaching residents how to teach: a one-year study. J Med Educ. 1982;57:361-6. Because residents assume a major portion of responsibility for clinical teaching and are usually unguided in this endeavor, a clinical teaching program was developed. Workshops and feedback sessions led to improved teaching and more confidence in this role. MedlineGoogle Scholar56. KANTORGRINER SP. Educational needs in general internal medicine as perceived by prior residents. J Med Educ. 1981;56:748-56. MedlineGoogle Scholar57. MCCUE J. Training internists: insights from private practice. Am J Med. 1981;71:475-9. These two articles, based on feedback from the private practice of internal medicine, argue for curricular changes designed to improve ambulatory continuity experience and to introduce conceptual issues not usually formally addressed, particularly those related to behavioral medicine. CrossrefMedlineGoogle Scholar58. LYLEBIANCHIHARRISWOOD CRJZ. Teaching cost containment to house officers at Charlotte Memorial Hospital. J Med Educ. 1979;54:856-62. MedlineGoogle Scholar59. MARTINWOLFTHIBODEAUDZAUBRAUNWALD AMLVE. A trial of two strategies to modify test-ordering behavior of medical residents. N Engl J Med. 1980;303:1330-6. These two studies describe cost-containment teaching strategies within internal medicine training programs using computerized hospital bills, encounter forms, concurrent chart review, and financial incentives. CrossrefMedlineGoogle Scholar60. MOOREKAMMERERMCGLYNNTRAUTLEINBURNSIDE RWTJJ. Consultations in internal medicine: a training program resource. J Med Educ. 1977;52:323-7. This audit study of a general medicine consultation service highlights the different spectrum of medical problems seen as compared with ward services, the interdisciplinary nature of the problems, and the educational value inherent in the experience. MedlineGoogle Scholar61. ROBBINSKAUSSHEINRICHABRASSDREYERCLYMAN ADRIJB. Interpersonal skills training: evaluation in an internal medicine residency. J Med Educ. 1979;54:885-94. A program using videotape feedback of housestaff-patient interactions was introduced into an internal medicine program to teach interpersonal skills. This proved to be an effective instructional technique that was well received by the trainees. MedlineGoogle Scholar62. SHEMOWITHERSTYSPRADLINWALDMAN JDWR. Psychiatry as an internal medicine subspecialty: an educational model. J Med Educ. 1980;55:354-61. Innovative program is described, in which the Departments of Psychiatry and Medicine merged and established multidisciplinary clinics and a conjoint inpatient service. Educational goals are discussed. MedlineGoogle Scholar63. SIEGELDONNELLY BJ. Enriching personal and professional development: the experience of a support group for interns. J Med Educ. 1978;53:908-14. Support groups have been advocated to facilitate new house officers' emotional adjustments to the internship. In this small study, the authors report on the structure, function, and favorable impact of these meetings. MedlineGoogle Scholar64. TOKARZBREMERPETERS JWK. Beyond Survival. Chicago: American Medical Association; 1979. This timely book, prepared by the Resident Physicians Section of the American Medical Association, addresses the issue of physician impairment and, specifically, the severity of the problem, innovative programs for management, and measures for prevention. Google Scholar65. WAGGONERFRENGLEYGRIGGSRAMMELKAMP DJRC. A 'firm' system for graduate training in general internal medicine. J Med Educ. 1979;54:556-61. Description of reorganization of a medicine training program into units that integrate inpatient and outpatient responsibilities, maximizing continuity of care and minimizing schedule conflicts. MedlineGoogle Scholar66. WIGTON R. A method for selecting which procedural skills should be learned by internal medicine residents. J Med Educ. 1981;56:512-7. By survey, a list was compiled of 30 procedures for which internal medicine residents should have mastery. One fourth of senior residents did not feel competent to do 13 of the 30 procedures. MedlineGoogle Scholar67. WIGTON R. Effect of lectures and increased experience in gastroenterology on examination scores of internal medicine residents. Gastroenterology. 1981;80:601-4. The effect of a lecture series and varying clinical experience on resident performance on a written examination was measured. Although the residents felt that knowledge was gained during a subspecialty rotation, this assessment was not confirmed. CrossrefMedlineGoogle Scholar68. BOUFFORD J. Primary care residency training: the first five years. Ann Intern Med. 1977;87:359-68. LinkGoogle Scholar69. GOROLLSTOECKLEGOLDFINGER AJS. Residency training in primary care internal medicine: report of an operational program. Ann Intern Med. 1975;83:872-7. Discussions of organizational evolution and curriculum content of two primary care programs are presented in these papers. LinkGoogle Scholar70. EISENBERG J. Curricula and organization of primary care residencies in internal medicine. J Med Educ. 1980;55:345-53. Survey of primary care programs in 1978, outlining demographic data and differences in organization and curricula between these programs and "traditional" tracks. MedlineGoogle Scholar71. GIACALONEHUDSON JJ. Primary care education trends in U.S. medical schools and teaching hospitals. J Med Educ. 1977;52:971-81. A survey by the American Association of Medical Colleges of primary care educational programs at undergraduate and graduate levels. Although continued emphasis on education in the ambulatory care arena was documented, well-defined loci for coordinating such activities at an institutional level were lacking. MedlineGoogle Scholar72. GOLDBERGPOZENCOHEN DJA. The effect of a primary-care pathway on internal medicine residents' career plans. Ann Intern Med. 1979;91:271-4. Data from this study suggests that a primary care pathway has a stabilizing effect on the career plans of residents in general internal medicine. Factors are discussed that may have influenced these career choices. LinkGoogle Scholar73. ROSINKSIDAGENAIS EF. A comparison of primary care residents with conventional internal medicine and pediatric residents. West J Med. 1981;135:245-7. A study of 15 primary care programs investigated how primary care residents are perceived by faculty and peers involved in "traditional" tracks at the same institutions. Primary care trainees were judged to be equal or better clinicians than their counterparts. MedlineGoogle Scholar74. SMITHEISENBERG EJ. Matrix organization of a residency program in an academic medical center. J Med Educ. 1980;55:758-64. The matrix management concept is discussed in the context of its application to the organization of a multidisciplinary primary care program in a university center. MedlineGoogle Scholar75. DWORINSTROSS AJ. The use of protocols as educational tools for house officers. J Med Educ. 1979;54:954-6. The use of a protocol for dysuria improved documentation of the history and diagnostic accuracy. Neither test ordering nor long-term follow-up improved. Physician acceptance was good. MedlineGoogle Scholar76. DUFFYHAMERMANCOHEN DDM. Communication skills of house officers: a study in a medical clinic. Ann Intern Med. 1980;93:354-7. This study identifies certain deficiencies in communication skills and offers meaningful solutions to enhance training and to improve patient care. LinkGoogle Scholar77. FLETCHERFLETCHER RS. The medical polyclinic: an approach to conflicting needs in a teaching hospital. J Med Educ. 1976;51:634-43. An innovative change was implemented at a university medical clinic. Emphasis was placed on each patient having a personal physician, expanding the concept of general medicine clinics and deleting subspecialty clinics. Advantages and disadvantages are discussed. MedlineGoogle Scholar78. FREIDINLAZERSON RA. Terminating the physician-patient relationship in primary care. JAMA. 1979;241:819-22. This is an excellent analysis of adverse outcomes resulting from termination of the patient-physician contact when the resident completes training. Guidelines for preparing the patient are presented. CrossrefMedlineGoogle Scholar79. LIANGCELLOMODLIN MJR. Teaching of primary care in an internal medicine residency program. Arch Intern Med. 1976;136:893-6. CrossrefMedlineGoogle Scholar80. MCGLYNNMUNZENRIDERZIZZO TRJ. A resident's internal medicine practice. Eval Health Prof. 1979;2:463-76. CrossrefMedlineGoogle Scholar81. PERLMANKENNEDYKAUFMANSILBERGLEITZELLERVEENHUIS LBJIJP. Training for primary care: use of the general medical clinic as a site for training medical residents. Arch Intern Med. 1974;133:448-51. These three articles are excellent descriptive reports of the outpatient practice setting. Resident professional and personal satisfaction was dependent on the opportunities for patient contact over an extended time period including several visits, faculty participation in a didactic and administrative mode, and a structured conference experience. CrossrefMedlineGoogle Scholar82. MCGLYNNWYNNMUNZENRIDER TJR. Resident education in primary care: how residents learn. J Med Educ. 1978;53:973-81. Several factors were identified that enhanced and inhibited the ambulatory practice training program experience. The faculty contributed significantly if they examined the patient with the resident and met directly with the resident to discuss the case. MedlineGoogle Scholar83. RUDDTULBROWNDAVIDSONBOSTWICK PVKSG. A general medicine clinic: the dilemma and teaching implications. J Med Educ. 1979;54:766-74. Deficiencies of an urban academic general medical clinic are highlighted. The most prominent was a poor patient mix evidenced by lack of new patient referrals and by inadequate exposure to new problems in patients already under longitudinal care. MedlineGoogle Scholar84. . Clinical competence in internal medicine. Ann Intern Med. 1979;90:402-11. The American Board of Internal Medicine competence statement for the internist delineates both the abilities and functions required. The statement serves to identify areas for education and assessment, but the challenge of how to assure attainment of these goals remains. LinkGoogle Scholar85. GORANWILLIAMSONGONNELLA MJJ. The validity of patient management problems. J Med Educ. 1973;48:171-7. MedlineGoogle Scholar86. PAGEFIELDING GD. Performance on PMPs and performance in practice: are they related? J Med Educ. 1980;55:529-37. Both studies point out the inadequacies of patient management problems. Although patient management problems provide an indication of performance, they are not a valid representation of performance in clinical practice. Discrepancies may be due to cuing and under-representation of time and economic constraints of practice on patient management problems. MedlineGoogle Scholar87. JELLYFRIEDMAN EC. An evaluation system for residency training. J Fam Pract. 1980;10:73-80. A model evaluation system is described that is based upon "systematic" rather than "episodic" evaluation of trainees. The system comprises a framework compatible with any training program format. MedlineGoogle Scholar88. NEUFELD V. In-training evaluation systems in residency education. Ann Coll Phys Surg Canada. 1981;14:286-90. A review of the evaluation programs used in postgraduate training is presented and issues of measurement, of feasibility, and of acceptability are discussed. Google Scholar89. RUTALASTILLMANSABERS PPD. Housestaff evaluation using patient instructors: report of clinical competence. Eval Health Prof. 1981;4:419-32. A program using non-physician patient instructors with stable cardiovascular or pulmonary findings was designed to quantify objectively selected critical components of clinical competence. Each trainee received a performance and content score, and these were correlated with traditional assessment methods. CrossrefGoogle Scholar90. TUDOR J. Performance documentation: how to confirm a resident's progress. J Med Educ. 1978;53:337-43. Description of "performance documentation" in postgraduate training. A cumulative documentation of clinical experiences and proficiency ratings is recorded and compared with program objectives. MedlineGoogle Scholar91. WEINERNATHANSON SM. Physical examination: frequently observed errors. JAMA. 1976;236:852-5. Detecting and correcting deficiencies in clinical skills is important in house officer training but is limited by the time and patience of clinical faculty. A method for directly observing skills of house officers is presented. CrossrefMedlineGoogle Scholar92. WIGTON R. Factors important in the evaluation of clinical performance of internal medicine residents. J Med Educ. 1980;55:206-8. Faculty and housestaff differ in dimensions they consider most important for assessing competence. Because each has different criteria for clinical excellence, participation by both groups is needed in development of categories for assessment. MedlineGoogle Scholar93. WOOJENROSENTHALBUNNGOLDMAN BPPHL. Anemic inpatients: correlates of house officer performance. Arch Intern Med. 1981;141:1199-202. Chart audit may aid in house officer evaluation and teaching. Explicit criteria mapping techniques documented differences in house officer performance that did not correlate with the subjective evaluations of faculty or supervising residents. CrossrefMedlineGoogle Scholar94. DAGGETTCASSIECOLLINS CJG. Research on clinical teaching. Rev Educ Res. 1979;49:151-69. Detailed review of literature on clinical teaching, including sociologic studies and teacher training programs. CrossrefGoogle Scholar95. IRBY D. Clinical teacher effectiveness in medicine. J Med Educ. 1978;53:808-15. MedlineGoogle Scholar96. STRITTERHAINGRIMES FJD. Clinical teaching reexamined. J Med Educ. 1975;50:876-82. Dimensions of clinical teaching that discriminate the best from the worst teachers are common to classroom teaching. They include: enthusiasm, clarity, organization, and facility in interacting with trainees. MedlineGoogle Scholar97. PATRIDGEHARRISPETZEL MIR. Implementation and evaluation of a faculty development program to improve clinical teaching. J Med Educ. 1980;55:711-3. MedlineGoogle Scholar98. STRITTERHAIN FJ. A workshop in clinical teaching. J Med Educ. 1977;52:155-7. These papers discuss teacher training courses for medical educators. Goals and methods of implementation of such programs are presented. All were met with enthusiasm by faculty. MedlineGoogle Scholar99. REULERGIRARDNARDONE JDD. The attending physician: privilege and pitfalls. JAMA. 1980;243:235-6. This commentary emphasizes the critical role that the attending physician plays in medical education. Guidelines are offered for discharging the many responsibilities of this position. CrossrefMedlineGoogle Scholar100. RUDD P Contrasts in academic consultation. Ann Intern Med. 1981;94:537-8. A brief and provocative discourse on the role of the attending physician on a consultation service in a teaching hospital. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: JAMES B. REULER, M.D.; DAVID A. NARDONE, M.D.; DIANE L. ELLIOT, M.D.; DONALD E. GIRARD, M.D.Affiliations: Portland, Oregon▸From the Division of General Medicine, Department of Medicine, Oregon Health Sciences University, and the Ambulatory Care and Medical Services, Veterans Administration Medical Center; Portland, Oregon. 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