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Medical Resident Education: A Cross-sectional Study of the Influence of the Ambulatory Preceptor as a Role Model

Medical Resident Education: A Cross-sectional Study of the Influence of the Ambulatory Preceptor... Abstract • A teaching practice of a residency program in primary care internal medicine was used for a cross-sectional study of the record-keeping habits of ambulatory preceptors and the residents they supervise. A retrospective review of 12 charts per physician over a six-month period was used to compare the charting behavior of three practice groups. Each group was comprised of an attending preceptor and a resident in each of the first, second, and third years of residency. Compared with the other two ambulatory preceptors, one ambulatory preceptor had significantly fewer charts with problem lists, medication lists, and health maintenance records as well as a lower ratio of psychosocial problems to total problems noted on his problem lists. The medical records of the residents supervised by this ambulatory preceptor were also significantly more deficient in each of these areas than the medical records of the other two resident groups. The fact that poor medical record keeping by an ambulatory preceptor was similarly deficient for the residents he supervised across each major area studied suggests that the ambulatory preceptor's actual practice behavior may exert a broad influence on the behavior of his residents. Future educational efforts in primary care internal medicine should be partially directed toward the ambulatory preceptors who serve as potent role models. (Arch Intern Med 1987;147:971-973) References 1. ABIM clinical competence in internal medicine. Ann Intern Med 1979;90:402-411.Crossref 2. Lipkin M, Quill TE, Napodano R: The medical interview: A core curriculum for residencies in internal medicine. Ann Intern Med 1984;100: 277-284.Crossref 3. Griner PF: Training of the general internist. Arch Intern Med 1977;137:1291-1298.Crossref 4. Council on General Internal Medicine: Attributes of the general internist and recommendations for training. Ann Intern Med 1977;86:472-473.Crossref 5. Institute of Medicine: Report of a Study: A Manpower Policy for Primary Health Care . Washington, DC, National Academy of Science, 1978. 6. Thompson TL, Byyny RL (eds): The Education of the General Internist . Denver, University of Colorado Press, 1982. 7. Goroll AH: Residency training in primary care internal medicine. Ann Intern Med 1975;83:872-877.Crossref 8. Berarducci AA, Delbanco TL, Rabkin M: The teaching hospital and primary care: Closing down the clinics. N Engl J Med 1975;292:615-620.Crossref 9. Novak D, Gordon G: Faculty development course. Med Encount 1983; 1:4-6. 10. Clark WD: SREPCIM's first course in medical interviewing. SREPCIM Newslett 1983;5:6. 11. Scott AJ. Continuing education: More or better? N Engl J Med 1976;295:444-445.Crossref 12. Sibley JC, Sackett DL, Neufeld V, et al: A randomized trial of continuing medical education. N Engl J Med 1982;306:511-515.Crossref 13. White CW, Albanese MA, Brown DD: The effectiveness of continuing medical education in changing the behavior of physicians caring for patients with acute myocardial infarction. Ann Intern Med 1985;102:686-692.Crossref 14. Weed LL: Medical Records, Medical Education, and Patient Care: The Problem-Oriented Medical Record as a Basic Tool . Cleveland, Case Western Reserve University Press, 1969. 15. Canadian Task Force on the Periodic Health Examination: The periodic health examination. Can Med Assoc J 1979;121:1193-1254. 16. Medical Practice Committee: Periodic health examination: A guide for designing individualized preventive health care in the asymptomatic patient. Ann Intern Med 1981;95:729-732.Crossref 17. Preventive Health Care Committee (Society for Research and Education in Primary Care Internal Medicine): Preventive medicine in general internal medicine residency training. Ann Intern Med 1985;102:859-861.Crossref 18. Napodano RJ, Schuster BL, Krackov S, et al: The use of private offices in education of residents in internal medicine. Arch Intern Med 1984;144: 303-305.Crossref 19. Schmale HA, Greene WA, Reichsman F, et al: An established program of graduate education in psychosomatic medicine. Adv Psychosom Med 1964;4:413. 20. Drossman DA: Can the primary care physician be better trained in the psychosocial aspect of patient care? Int J Psychiatry Med 1978;8:169-184.Crossref 21. The Classification Committee of WONCA: International Classification of Health Problems in Primary Care , 1979 revision. New York, Oxford University Press Inc, 1979. 22. Houpt JL, Orleans CS, George LK, et al: Importance of Mental Health Services of General Health Care . Cambridge, Mass, Ballinger Publishing Co, 1979. 23. White KL, Williams TG, Greenberg BG: The ecology of medical care. N Engl J Med 1961;265:885-892.Crossref 24. Jencks SF: Recognition of mental distress and diagnosis of mental disorder in primary care. JAMA 1985;253:1903-1907.Crossref 25. Nielsen AC, Williams TA: Depression in ambulatory medical patients. Arch Gen Psychiatry 1985;37:999-1004.Crossref 26. Barsky AJ: Hidden reasons some patients visit doctors. Ann Intern Med 1981:94(pt 1):492-498.Crossref 27. Quill TE: Somatization disorder: One of medicine's blind spots. JAMA 1985;254:3075-3079.Crossref 28. Casey PR, Dillon S, Tyrer PJ: The diagnostic status of patients with conspicuous psychiatric morbidity in primary care. Psychol Med 1984;14: 673-681.Crossref 29. Linn LS, Yager J: Recognition of depression and anxiety by primary physicians. Psychosomatics 1984;25:593-595, 599-600.Crossref 30. Verbrugge LM: How physicians treat mentally distressed men and women. Soc Sci Med 1984;18:1-9.Crossref 31. KosecoffJ, Fink A, Brook RH: General medical care and the education of internists in university hospitals. Ann Intern Med 1985;102:250-257.Crossref 32. Engel GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-544. 33. Pincus HA, Strain JJ, Houpt JL, et al: Models of mental health training in primary care. JAMA 1983;249:3065-3068.Crossref 34. Engel GL: The biopsychosocial model and medical education: Who are to be the teachers? N Engl J Med 1982;306:802.Crossref 35. Frisch SR, Boucher FG, Charbonneau S, et al: Increasing the effectiveness of clinical supervision. Can Med Assoc J 1984;131:569-572. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Medical Resident Education: A Cross-sectional Study of the Influence of the Ambulatory Preceptor as a Role Model

Archives of Internal Medicine , Volume 147 (5) – May 1, 1987

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1987.00370050163027
Publisher site
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Abstract

Abstract • A teaching practice of a residency program in primary care internal medicine was used for a cross-sectional study of the record-keeping habits of ambulatory preceptors and the residents they supervise. A retrospective review of 12 charts per physician over a six-month period was used to compare the charting behavior of three practice groups. Each group was comprised of an attending preceptor and a resident in each of the first, second, and third years of residency. Compared with the other two ambulatory preceptors, one ambulatory preceptor had significantly fewer charts with problem lists, medication lists, and health maintenance records as well as a lower ratio of psychosocial problems to total problems noted on his problem lists. The medical records of the residents supervised by this ambulatory preceptor were also significantly more deficient in each of these areas than the medical records of the other two resident groups. The fact that poor medical record keeping by an ambulatory preceptor was similarly deficient for the residents he supervised across each major area studied suggests that the ambulatory preceptor's actual practice behavior may exert a broad influence on the behavior of his residents. Future educational efforts in primary care internal medicine should be partially directed toward the ambulatory preceptors who serve as potent role models. (Arch Intern Med 1987;147:971-973) References 1. ABIM clinical competence in internal medicine. Ann Intern Med 1979;90:402-411.Crossref 2. Lipkin M, Quill TE, Napodano R: The medical interview: A core curriculum for residencies in internal medicine. Ann Intern Med 1984;100: 277-284.Crossref 3. Griner PF: Training of the general internist. Arch Intern Med 1977;137:1291-1298.Crossref 4. Council on General Internal Medicine: Attributes of the general internist and recommendations for training. Ann Intern Med 1977;86:472-473.Crossref 5. Institute of Medicine: Report of a Study: A Manpower Policy for Primary Health Care . Washington, DC, National Academy of Science, 1978. 6. Thompson TL, Byyny RL (eds): The Education of the General Internist . Denver, University of Colorado Press, 1982. 7. Goroll AH: Residency training in primary care internal medicine. Ann Intern Med 1975;83:872-877.Crossref 8. Berarducci AA, Delbanco TL, Rabkin M: The teaching hospital and primary care: Closing down the clinics. N Engl J Med 1975;292:615-620.Crossref 9. Novak D, Gordon G: Faculty development course. Med Encount 1983; 1:4-6. 10. Clark WD: SREPCIM's first course in medical interviewing. SREPCIM Newslett 1983;5:6. 11. Scott AJ. Continuing education: More or better? N Engl J Med 1976;295:444-445.Crossref 12. Sibley JC, Sackett DL, Neufeld V, et al: A randomized trial of continuing medical education. N Engl J Med 1982;306:511-515.Crossref 13. White CW, Albanese MA, Brown DD: The effectiveness of continuing medical education in changing the behavior of physicians caring for patients with acute myocardial infarction. Ann Intern Med 1985;102:686-692.Crossref 14. Weed LL: Medical Records, Medical Education, and Patient Care: The Problem-Oriented Medical Record as a Basic Tool . Cleveland, Case Western Reserve University Press, 1969. 15. Canadian Task Force on the Periodic Health Examination: The periodic health examination. Can Med Assoc J 1979;121:1193-1254. 16. Medical Practice Committee: Periodic health examination: A guide for designing individualized preventive health care in the asymptomatic patient. Ann Intern Med 1981;95:729-732.Crossref 17. Preventive Health Care Committee (Society for Research and Education in Primary Care Internal Medicine): Preventive medicine in general internal medicine residency training. Ann Intern Med 1985;102:859-861.Crossref 18. Napodano RJ, Schuster BL, Krackov S, et al: The use of private offices in education of residents in internal medicine. Arch Intern Med 1984;144: 303-305.Crossref 19. Schmale HA, Greene WA, Reichsman F, et al: An established program of graduate education in psychosomatic medicine. Adv Psychosom Med 1964;4:413. 20. Drossman DA: Can the primary care physician be better trained in the psychosocial aspect of patient care? Int J Psychiatry Med 1978;8:169-184.Crossref 21. The Classification Committee of WONCA: International Classification of Health Problems in Primary Care , 1979 revision. New York, Oxford University Press Inc, 1979. 22. Houpt JL, Orleans CS, George LK, et al: Importance of Mental Health Services of General Health Care . Cambridge, Mass, Ballinger Publishing Co, 1979. 23. White KL, Williams TG, Greenberg BG: The ecology of medical care. N Engl J Med 1961;265:885-892.Crossref 24. Jencks SF: Recognition of mental distress and diagnosis of mental disorder in primary care. JAMA 1985;253:1903-1907.Crossref 25. Nielsen AC, Williams TA: Depression in ambulatory medical patients. Arch Gen Psychiatry 1985;37:999-1004.Crossref 26. Barsky AJ: Hidden reasons some patients visit doctors. Ann Intern Med 1981:94(pt 1):492-498.Crossref 27. Quill TE: Somatization disorder: One of medicine's blind spots. JAMA 1985;254:3075-3079.Crossref 28. Casey PR, Dillon S, Tyrer PJ: The diagnostic status of patients with conspicuous psychiatric morbidity in primary care. Psychol Med 1984;14: 673-681.Crossref 29. Linn LS, Yager J: Recognition of depression and anxiety by primary physicians. Psychosomatics 1984;25:593-595, 599-600.Crossref 30. Verbrugge LM: How physicians treat mentally distressed men and women. Soc Sci Med 1984;18:1-9.Crossref 31. KosecoffJ, Fink A, Brook RH: General medical care and the education of internists in university hospitals. Ann Intern Med 1985;102:250-257.Crossref 32. Engel GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-544. 33. Pincus HA, Strain JJ, Houpt JL, et al: Models of mental health training in primary care. JAMA 1983;249:3065-3068.Crossref 34. Engel GL: The biopsychosocial model and medical education: Who are to be the teachers? N Engl J Med 1982;306:802.Crossref 35. Frisch SR, Boucher FG, Charbonneau S, et al: Increasing the effectiveness of clinical supervision. Can Med Assoc J 1984;131:569-572.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1987

References