Michael Battistone - Academia.edu (original) (raw)

Papers by Michael Battistone

Diagnosis, 2020

The diagnostic error crisis suggests a shift in how we view clinical reasoning and may be vital f... more The diagnostic error crisis suggests a shift in how we view clinical reasoning and may be vital for transforming how we view clinical encounters. Building upon the literature, we propose clinical reasoning and error are context-specific and proceed to advance a family of theories that represent a model outlining the complex interplay of physician, patient, and environmental factors driving clinical reasoning and error. These contemporary social cognitive theories (i.e. embedded cognition, ecological psychology, situated cognition, and distributed cognition) can emphasize the dynamic interactions occurring amongst participants in particular settings. The situational determinants that contribute to diagnostic error are also explored.

Annals of Internal Medicine, 2005

Arthritis & Rheumatism, 2013

To analyze the distribution of rheumatology practices in the US and factors associated with that ... more To analyze the distribution of rheumatology practices in the US and factors associated with that distribution, in order to better understand the supply of the rheumatology workforce. Using the American College of Rheumatology membership database, all practicing adult rheumatologist office addresses were mapped with ArcView software. The number of rheumatologists per Core Based Statistical Area (CBSA) was calculated. To investigate whether sociodemographic factors correlated with clustering of rheumatologists, covariates from the 2010 US Census for each CBSA, including age, sex, race/ethnicity, and median household income, were modeled. Many CBSAs, predominantly smaller micropolitan areas, did not have a practicing rheumatologist. For some of these smaller micropolitan areas (with populations of at least 40,000), the closest practicing rheumatologist was more than 200 miles away. However, we also identified several more-populous areas (populations of 200,000 or more) without a practicing rheumatologist. Greater numbers of rheumatologists were more likely to practice in areas with higher population densities and higher median incomes. More rheumatologists were also found in CBSAs in which there were rheumatology training programs. These findings demonstrate that many smaller regions of the country have no or few practicing adult rheumatologists. Patients with chronic rheumatic conditions in these areas likely have limited access to rheumatology care. Policy changes could address potential regional rheumatology workforce shortages, but limitations of the current data would need to be addressed prior to implementation of such changes.

Clinical Medicine Insights: Therapeutics, 2010

ABSTRACT Osteoarthritis is a major cause for pain worldwide and is increasingly so as the number ... more ABSTRACT Osteoarthritis is a major cause for pain worldwide and is increasingly so as the number of elderly people continues to grow. Finding treatments that are effective and safe for this pain has been challenging primarily because gastrointestinal risks increase with aging as well. One step in the direction of improvement was the development of selective COX-2 inhibitors, which as a group have lower gastrointestinal adverse reaction rates than traditional non-steroidal anti-inflammatory drugs. However, increases in cardiovascu - lar adverse events with some of these have dampened initial enthusiasm for this approach. One of these inhibitors, celecoxib remains available in most areas of the world for use in pain associated with osteoarthritis. This review illustrates how best to consider it's role in the current treatment of pain associated with arthritis with an emphasis on osteoarthritis.

Arthritis & Rheumatism, 2013

To analyze the distribution of rheumatology practices in the US and factors associated with that ... more To analyze the distribution of rheumatology practices in the US and factors associated with that distribution, in order to better understand the supply of the rheumatology workforce. Using the American College of Rheumatology membership database, all practicing adult rheumatologist office addresses were mapped with ArcView software. The number of rheumatologists per Core Based Statistical Area (CBSA) was calculated. To investigate whether sociodemographic factors correlated with clustering of rheumatologists, covariates from the 2010 US Census for each CBSA, including age, sex, race/ethnicity, and median household income, were modeled. Many CBSAs, predominantly smaller micropolitan areas, did not have a practicing rheumatologist. For some of these smaller micropolitan areas (with populations of at least 40,000), the closest practicing rheumatologist was more than 200 miles away. However, we also identified several more-populous areas (populations of 200,000 or more) without a practicing rheumatologist. Greater numbers of rheumatologists were more likely to practice in areas with higher population densities and higher median incomes. More rheumatologists were also found in CBSAs in which there were rheumatology training programs. These findings demonstrate that many smaller regions of the country have no or few practicing adult rheumatologists. Patients with chronic rheumatic conditions in these areas likely have limited access to rheumatology care. Policy changes could address potential regional rheumatology workforce shortages, but limitations of the current data would need to be addressed prior to implementation of such changes.

International journal of rheumatology, 2012

Introduction. Accurate blood pressure (BP) measurement is essential to the diagnosis and manageme... more Introduction. Accurate blood pressure (BP) measurement is essential to the diagnosis and management of hypertension in patients with systemic sclerosis (SSc) to help prevent renal and cardiovascular complications. The presence of an auscultatory gap during manual BP measurement-the temporary disappearance of the Korotkoff sounds during cuff deflation-leads to a potentially important underestimate of systolic BP if undetected. Objectives. Since the presence of an auscultatory gap is frequently associated with increased vascular stiffness, we investigated its presence and correlates in 50 consecutive SSc patients. Methods. For each patient, BP was measured sequentially using three different approaches performed in the same order. Results. Sixteen of 50 patients (32%) had an auscultatory gap which if undetected would have resulted in clinically important underestimates of systolic BP in 4 patients. The presence of an auscultatory gap was statistically associated with the presence of an...

Teaching and Learning in Medicine, 2014

Teaching and Learning in Medicine, 2003

Changes in academic medicine have left clerkship directors (CDs) anxious about their career pathw... more Changes in academic medicine have left clerkship directors (CDs) anxious about their career pathway, because clerkship administrative efforts may detract from other activities. The Clerkship Directors in Internal Medicine (CDIM) asked members about benefits of being a CD or CDIM membership toward career development. Responses were on 1-5 Likert scales with 5 (strongly agree). Background and demographic issues were analyzed for associations with the career benefits statements. The response rate was 75% (n = 92). Mean agreement with CD benefit was 4.2 (SD = 0.82) and CDIM membership 3.8 (SD = 0.95). Eighty-one percent and 58% of CDs agreed with the respective statements. Significant predictors of CD benefit were CD and coordinator salary support, years as CD, and receiving a university teaching award. Structured discussions of expectations strongly predicted perceiving CDIM benefit. Most CDs agreed that their CD role and CDIM benefited their careers. Salary support and clearly defining expectations may increase the likelihood of perceiving benefit.

Teaching and Learning in Medicine, 2014

This journal watch is sponsored by the Alliance for Clinical Education (ACE). The purpose of this... more This journal watch is sponsored by the Alliance for Clinical Education (ACE). The purpose of this article is to summarize medical education manuscripts from specialty journals that are important and relevant to educators across specialties. Specialties included in our review were cardiology, gastroenterology, general internal medicine, pulmonology, nephrology, hematology and oncology, endocrinology, rheumatology, infectious disease, and neurology. We are grateful

Teaching and Learning in Medicine, 2002

A systematized approach to descriptive evaluation of clinical performance using a vocabulary of g... more A systematized approach to descriptive evaluation of clinical performance using a vocabulary of global descriptors in the setting of formal evaluation and feedback sessions has been shown to be reliable and valid. The feasibility of this method beyond the institution at which it was developed has not been studied. To determine the feasibility and acceptability of implementing formal evaluation and feedback sessions, using a vocabulary of global descriptors, in a third-year core clinical clerkship. In 1997, the University of Utah internal medicine clerkship introduced an evaluation method in which student performance was discussed at formal sessions, using a taxonomy of global terms describing progressive development from "reporter" to "interpreter" to "manager/educator" (R-I-M-E). The sessions were face-to-face meetings between the clinical teachers and a clerkship director, at three-week intervals through the twelve-week clerkship at the inpatient teaching sites. Following the evaluation session students met individually with the clerkship director for feedback. To determine feasibility, the authors estimated the time and resources necessary to administer the system and recorded actual teacher attendance over 2 academic years (1997-99). Anonymous surveys, using a four-point, Likert-type scale, were used to determine acceptance of the method by faculty, residents, and students. Attendance was high for residents (79%) and faculty (72%). Mean survey responses from residents and faculty rated the descriptive system "more valid" than the previous method. A majority of the students rated the method as either "helpful" (30%) or "very helpful" (50%). Time requirement for eight to ten students at each teaching site, for evaluation and feedback sessions was one-half day per week of the clerkship director, every three weeks. Our experience establishes the feasibility of implementing this system of formal evaluation and feedback, using descriptive vocabulary, beyond the institution at which it was developed. Students, residents, and faculty endorsed this evaluation system and the survey results suggest substantial utility and face validity.

JAMA, 2008

Context Shortfalls in the US physician workforce are anticipated as the population ages and medic... more Context Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine (IM) has declined (particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear.

Clinical Rheumatology, 2013

We performed bedside testing for peripheral neuropathy in our systemic sclerosis (SSc) population... more We performed bedside testing for peripheral neuropathy in our systemic sclerosis (SSc) population to determine whether foot care guidelines should be developed for SSc. Twenty consecutive SSc patients and 20 healthy control (HC) patients were evaluated for peripheral neuropathy in both feet using the 10-g Semmes-Weinstein monofilament examination (SWME) and 128 Hz vibration sensation using the on-off method. Independent, blinded, vibratory sensation, and SWME evaluations were performed on each subject by two investigators who had completed a training session to standardize each exam. An additional consecutive 20 patients with type 2 diabetes mellitus (DM) were examined by a diabetologist to compare with peripheral neuropathy prevalence in SSc patients. We examined the inter-rater variability using Cohen's kappa. We compared SWME and vibratory sensation in SSc to HC using Fisher's exact. The t test was used to compare duration of disease and modified Rodnan skin score (mRSS) for those with abnormal SWME or vibratory sensation. Two of 20 SSc patients reported sensory foot symptoms consistent with peripheral neuropathy prior to the examination. Inter-rater agreement for both SWME and vibratory sensation was strong (kappa: 0.72 and 0.83, respectively). Two HC and 12 SSc patients demonstrated abnormal vibratory sense (one-sided Fishers' exact, p < 0.002). No HC and four SSc patients had abnormal monofilament exams (one-sided Fisher's exact, p = 0.053). Neither mRSS (p = 0.28) nor duration of non-Raynauds (p = 0.07) symptoms differed between those with peripheral neuropathy and those without. Duration of Raynaud's symptoms were clinically significantly associated with presence of peripheral neuropathy (p = 0.04). The prevalence of sensory loss to monofilament in SSc was identical to DM patients (4/20). SSc patients have a considerable prevalence of pedal peripheral neuropathy as detected by loss of vibratory sensation or inability to sense the 10-g SWME. Further studies are indicated to determine if routine screening for neuropathy and subsequent podiatric care for SSc patients with abnormalities can reduce pedal complications.

Academic Medicine, 2001

To characterize the responsibilities, activities, and scholarly productivity of internal medicine... more To characterize the responsibilities, activities, and scholarly productivity of internal medicine clerkship directors (CDs). In 1999, internal medicine CDs from 122 U.S. medical schools and one Canadian medical school were surveyed. The instrument asked about the CDs' demo-graphics, workloads, clerkship characteristics, and scholarly productivity. The response rate was 89%; 72% of the respondents were men. Mean age was 45 years, mean time as CD was 6.5 years, and 58% of the CDs had completed fellowship training. The CDs spent 28% of their professional time on the clerkship, three half days weekly in clinic, and three months on inpatient services. The CDs had published a mean of 2.2 (range 0-20) articles and received a mean of 0.7 (range 0-4) grants. Similar factors were associated with publishing articles and receiving grants; gender (men), < or = three clinic half days weekly, fellowship training, having a faculty development program, teaching other courses, and discussing expectations with their department chairs. In a multivariate analysis, fellowship training, clinic half days, teaching other courses, and discussing expectations explained 22% of the variance for papers published. For grants received, a model with gender, clinic half days, a faculty development program, discussing expectations, and teaching other courses explained 35% of the variance. An internal medicine CD invests significant effort administering the clerkship and contributing to clinical and educational activities. The factors associated with successful scholarship may be useful for fostering CDs' academic careers.

Academic Medicine, 2001

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > October ...

Academic Medicine, 2005

Whether attending physicians, residents, nurses, and medical students agree on what constitutes m... more Whether attending physicians, residents, nurses, and medical students agree on what constitutes medical student abuse, its severity, or influencing factors is unknown.

Academic Medicine, 2011

Medical students&... more Medical students' career choices affect health care. To understand how to increase the number of students who choose careers in internal medicine (IM), students who seriously considered IM but chose another field ("Switchers") and those who rejected IM ("Never Considered") were compared with those who chose IM ("Choosers"). Fourth-year medical students from 11 U.S. institutions were surveyed about demographics, medical school educational experiences, and aspects of the specialty of IM. Univariate analysis and multivariate logistic regression models examined associations between student characteristics and classification as Switchers, Choosers, and Never Considered. A total of 1,177 students completed the survey (82% response rate). There were 274 (23%) Choosers, 398 (34%) Switchers, and 499 (43%) Never Considered. The authors' models explained over 80% of variance in these three career choice classification groups. For most responses, an increasingly favorable gradient from Never Considered to Choosers was observed. Multivariate analysis revealed six items that were associated with higher probability of choosing IM: types of patients internists see, timing of career decision, interest groups, intellectual challenge, satisfaction among internists, and the core IM clerkship. Several potentially modifiable educational experiences and aspects of IM distinguished Switchers from the other two groups. The percentage of variance explained by group suggests that these findings identify important underpinnings of career decisions. These items also suggest ways that educational experiences and aspects of the specialty could be redesigned by academicians and policy makers to improve the attractiveness of IM careers.

Diagnosis, 2020

The diagnostic error crisis suggests a shift in how we view clinical reasoning and may be vital f... more The diagnostic error crisis suggests a shift in how we view clinical reasoning and may be vital for transforming how we view clinical encounters. Building upon the literature, we propose clinical reasoning and error are context-specific and proceed to advance a family of theories that represent a model outlining the complex interplay of physician, patient, and environmental factors driving clinical reasoning and error. These contemporary social cognitive theories (i.e. embedded cognition, ecological psychology, situated cognition, and distributed cognition) can emphasize the dynamic interactions occurring amongst participants in particular settings. The situational determinants that contribute to diagnostic error are also explored.

Annals of Internal Medicine, 2005

Arthritis & Rheumatism, 2013

To analyze the distribution of rheumatology practices in the US and factors associated with that ... more To analyze the distribution of rheumatology practices in the US and factors associated with that distribution, in order to better understand the supply of the rheumatology workforce. Using the American College of Rheumatology membership database, all practicing adult rheumatologist office addresses were mapped with ArcView software. The number of rheumatologists per Core Based Statistical Area (CBSA) was calculated. To investigate whether sociodemographic factors correlated with clustering of rheumatologists, covariates from the 2010 US Census for each CBSA, including age, sex, race/ethnicity, and median household income, were modeled. Many CBSAs, predominantly smaller micropolitan areas, did not have a practicing rheumatologist. For some of these smaller micropolitan areas (with populations of at least 40,000), the closest practicing rheumatologist was more than 200 miles away. However, we also identified several more-populous areas (populations of 200,000 or more) without a practicing rheumatologist. Greater numbers of rheumatologists were more likely to practice in areas with higher population densities and higher median incomes. More rheumatologists were also found in CBSAs in which there were rheumatology training programs. These findings demonstrate that many smaller regions of the country have no or few practicing adult rheumatologists. Patients with chronic rheumatic conditions in these areas likely have limited access to rheumatology care. Policy changes could address potential regional rheumatology workforce shortages, but limitations of the current data would need to be addressed prior to implementation of such changes.

Clinical Medicine Insights: Therapeutics, 2010

ABSTRACT Osteoarthritis is a major cause for pain worldwide and is increasingly so as the number ... more ABSTRACT Osteoarthritis is a major cause for pain worldwide and is increasingly so as the number of elderly people continues to grow. Finding treatments that are effective and safe for this pain has been challenging primarily because gastrointestinal risks increase with aging as well. One step in the direction of improvement was the development of selective COX-2 inhibitors, which as a group have lower gastrointestinal adverse reaction rates than traditional non-steroidal anti-inflammatory drugs. However, increases in cardiovascu - lar adverse events with some of these have dampened initial enthusiasm for this approach. One of these inhibitors, celecoxib remains available in most areas of the world for use in pain associated with osteoarthritis. This review illustrates how best to consider it's role in the current treatment of pain associated with arthritis with an emphasis on osteoarthritis.

Arthritis & Rheumatism, 2013

To analyze the distribution of rheumatology practices in the US and factors associated with that ... more To analyze the distribution of rheumatology practices in the US and factors associated with that distribution, in order to better understand the supply of the rheumatology workforce. Using the American College of Rheumatology membership database, all practicing adult rheumatologist office addresses were mapped with ArcView software. The number of rheumatologists per Core Based Statistical Area (CBSA) was calculated. To investigate whether sociodemographic factors correlated with clustering of rheumatologists, covariates from the 2010 US Census for each CBSA, including age, sex, race/ethnicity, and median household income, were modeled. Many CBSAs, predominantly smaller micropolitan areas, did not have a practicing rheumatologist. For some of these smaller micropolitan areas (with populations of at least 40,000), the closest practicing rheumatologist was more than 200 miles away. However, we also identified several more-populous areas (populations of 200,000 or more) without a practicing rheumatologist. Greater numbers of rheumatologists were more likely to practice in areas with higher population densities and higher median incomes. More rheumatologists were also found in CBSAs in which there were rheumatology training programs. These findings demonstrate that many smaller regions of the country have no or few practicing adult rheumatologists. Patients with chronic rheumatic conditions in these areas likely have limited access to rheumatology care. Policy changes could address potential regional rheumatology workforce shortages, but limitations of the current data would need to be addressed prior to implementation of such changes.

International journal of rheumatology, 2012

Introduction. Accurate blood pressure (BP) measurement is essential to the diagnosis and manageme... more Introduction. Accurate blood pressure (BP) measurement is essential to the diagnosis and management of hypertension in patients with systemic sclerosis (SSc) to help prevent renal and cardiovascular complications. The presence of an auscultatory gap during manual BP measurement-the temporary disappearance of the Korotkoff sounds during cuff deflation-leads to a potentially important underestimate of systolic BP if undetected. Objectives. Since the presence of an auscultatory gap is frequently associated with increased vascular stiffness, we investigated its presence and correlates in 50 consecutive SSc patients. Methods. For each patient, BP was measured sequentially using three different approaches performed in the same order. Results. Sixteen of 50 patients (32%) had an auscultatory gap which if undetected would have resulted in clinically important underestimates of systolic BP in 4 patients. The presence of an auscultatory gap was statistically associated with the presence of an...

Teaching and Learning in Medicine, 2014

Teaching and Learning in Medicine, 2003

Changes in academic medicine have left clerkship directors (CDs) anxious about their career pathw... more Changes in academic medicine have left clerkship directors (CDs) anxious about their career pathway, because clerkship administrative efforts may detract from other activities. The Clerkship Directors in Internal Medicine (CDIM) asked members about benefits of being a CD or CDIM membership toward career development. Responses were on 1-5 Likert scales with 5 (strongly agree). Background and demographic issues were analyzed for associations with the career benefits statements. The response rate was 75% (n = 92). Mean agreement with CD benefit was 4.2 (SD = 0.82) and CDIM membership 3.8 (SD = 0.95). Eighty-one percent and 58% of CDs agreed with the respective statements. Significant predictors of CD benefit were CD and coordinator salary support, years as CD, and receiving a university teaching award. Structured discussions of expectations strongly predicted perceiving CDIM benefit. Most CDs agreed that their CD role and CDIM benefited their careers. Salary support and clearly defining expectations may increase the likelihood of perceiving benefit.

Teaching and Learning in Medicine, 2014

This journal watch is sponsored by the Alliance for Clinical Education (ACE). The purpose of this... more This journal watch is sponsored by the Alliance for Clinical Education (ACE). The purpose of this article is to summarize medical education manuscripts from specialty journals that are important and relevant to educators across specialties. Specialties included in our review were cardiology, gastroenterology, general internal medicine, pulmonology, nephrology, hematology and oncology, endocrinology, rheumatology, infectious disease, and neurology. We are grateful

Teaching and Learning in Medicine, 2002

A systematized approach to descriptive evaluation of clinical performance using a vocabulary of g... more A systematized approach to descriptive evaluation of clinical performance using a vocabulary of global descriptors in the setting of formal evaluation and feedback sessions has been shown to be reliable and valid. The feasibility of this method beyond the institution at which it was developed has not been studied. To determine the feasibility and acceptability of implementing formal evaluation and feedback sessions, using a vocabulary of global descriptors, in a third-year core clinical clerkship. In 1997, the University of Utah internal medicine clerkship introduced an evaluation method in which student performance was discussed at formal sessions, using a taxonomy of global terms describing progressive development from "reporter" to "interpreter" to "manager/educator" (R-I-M-E). The sessions were face-to-face meetings between the clinical teachers and a clerkship director, at three-week intervals through the twelve-week clerkship at the inpatient teaching sites. Following the evaluation session students met individually with the clerkship director for feedback. To determine feasibility, the authors estimated the time and resources necessary to administer the system and recorded actual teacher attendance over 2 academic years (1997-99). Anonymous surveys, using a four-point, Likert-type scale, were used to determine acceptance of the method by faculty, residents, and students. Attendance was high for residents (79%) and faculty (72%). Mean survey responses from residents and faculty rated the descriptive system "more valid" than the previous method. A majority of the students rated the method as either "helpful" (30%) or "very helpful" (50%). Time requirement for eight to ten students at each teaching site, for evaluation and feedback sessions was one-half day per week of the clerkship director, every three weeks. Our experience establishes the feasibility of implementing this system of formal evaluation and feedback, using descriptive vocabulary, beyond the institution at which it was developed. Students, residents, and faculty endorsed this evaluation system and the survey results suggest substantial utility and face validity.

JAMA, 2008

Context Shortfalls in the US physician workforce are anticipated as the population ages and medic... more Context Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine (IM) has declined (particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear.

Clinical Rheumatology, 2013

We performed bedside testing for peripheral neuropathy in our systemic sclerosis (SSc) population... more We performed bedside testing for peripheral neuropathy in our systemic sclerosis (SSc) population to determine whether foot care guidelines should be developed for SSc. Twenty consecutive SSc patients and 20 healthy control (HC) patients were evaluated for peripheral neuropathy in both feet using the 10-g Semmes-Weinstein monofilament examination (SWME) and 128 Hz vibration sensation using the on-off method. Independent, blinded, vibratory sensation, and SWME evaluations were performed on each subject by two investigators who had completed a training session to standardize each exam. An additional consecutive 20 patients with type 2 diabetes mellitus (DM) were examined by a diabetologist to compare with peripheral neuropathy prevalence in SSc patients. We examined the inter-rater variability using Cohen's kappa. We compared SWME and vibratory sensation in SSc to HC using Fisher's exact. The t test was used to compare duration of disease and modified Rodnan skin score (mRSS) for those with abnormal SWME or vibratory sensation. Two of 20 SSc patients reported sensory foot symptoms consistent with peripheral neuropathy prior to the examination. Inter-rater agreement for both SWME and vibratory sensation was strong (kappa: 0.72 and 0.83, respectively). Two HC and 12 SSc patients demonstrated abnormal vibratory sense (one-sided Fishers' exact, p < 0.002). No HC and four SSc patients had abnormal monofilament exams (one-sided Fisher's exact, p = 0.053). Neither mRSS (p = 0.28) nor duration of non-Raynauds (p = 0.07) symptoms differed between those with peripheral neuropathy and those without. Duration of Raynaud's symptoms were clinically significantly associated with presence of peripheral neuropathy (p = 0.04). The prevalence of sensory loss to monofilament in SSc was identical to DM patients (4/20). SSc patients have a considerable prevalence of pedal peripheral neuropathy as detected by loss of vibratory sensation or inability to sense the 10-g SWME. Further studies are indicated to determine if routine screening for neuropathy and subsequent podiatric care for SSc patients with abnormalities can reduce pedal complications.

Academic Medicine, 2001

To characterize the responsibilities, activities, and scholarly productivity of internal medicine... more To characterize the responsibilities, activities, and scholarly productivity of internal medicine clerkship directors (CDs). In 1999, internal medicine CDs from 122 U.S. medical schools and one Canadian medical school were surveyed. The instrument asked about the CDs' demo-graphics, workloads, clerkship characteristics, and scholarly productivity. The response rate was 89%; 72% of the respondents were men. Mean age was 45 years, mean time as CD was 6.5 years, and 58% of the CDs had completed fellowship training. The CDs spent 28% of their professional time on the clerkship, three half days weekly in clinic, and three months on inpatient services. The CDs had published a mean of 2.2 (range 0-20) articles and received a mean of 0.7 (range 0-4) grants. Similar factors were associated with publishing articles and receiving grants; gender (men), < or = three clinic half days weekly, fellowship training, having a faculty development program, teaching other courses, and discussing expectations with their department chairs. In a multivariate analysis, fellowship training, clinic half days, teaching other courses, and discussing expectations explained 22% of the variance for papers published. For grants received, a model with gender, clinic half days, a faculty development program, discussing expectations, and teaching other courses explained 35% of the variance. An internal medicine CD invests significant effort administering the clerkship and contributing to clinical and educational activities. The factors associated with successful scholarship may be useful for fostering CDs' academic careers.

Academic Medicine, 2001

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > October ...

Academic Medicine, 2005

Whether attending physicians, residents, nurses, and medical students agree on what constitutes m... more Whether attending physicians, residents, nurses, and medical students agree on what constitutes medical student abuse, its severity, or influencing factors is unknown.

Academic Medicine, 2011

Medical students&... more Medical students' career choices affect health care. To understand how to increase the number of students who choose careers in internal medicine (IM), students who seriously considered IM but chose another field ("Switchers") and those who rejected IM ("Never Considered") were compared with those who chose IM ("Choosers"). Fourth-year medical students from 11 U.S. institutions were surveyed about demographics, medical school educational experiences, and aspects of the specialty of IM. Univariate analysis and multivariate logistic regression models examined associations between student characteristics and classification as Switchers, Choosers, and Never Considered. A total of 1,177 students completed the survey (82% response rate). There were 274 (23%) Choosers, 398 (34%) Switchers, and 499 (43%) Never Considered. The authors' models explained over 80% of variance in these three career choice classification groups. For most responses, an increasingly favorable gradient from Never Considered to Choosers was observed. Multivariate analysis revealed six items that were associated with higher probability of choosing IM: types of patients internists see, timing of career decision, interest groups, intellectual challenge, satisfaction among internists, and the core IM clerkship. Several potentially modifiable educational experiences and aspects of IM distinguished Switchers from the other two groups. The percentage of variance explained by group suggests that these findings identify important underpinnings of career decisions. These items also suggest ways that educational experiences and aspects of the specialty could be redesigned by academicians and policy makers to improve the attractiveness of IM careers.