The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.

To analyze physician work production over a 5-year period to discover trends in productivity.

Surgical workforce calculations over the past 25 years have projected major oversupply as well as looming shortages. Recent studies indicate that demand for surgical services will increase over the next two decades as the population ages and develops age related chronic diseases. This study examines actual physician productivity to determine whether there is capacity for increased work output in response to projected increases in demand.

Physician productivity data as measured by relative value units were obtained from the Medical Group Management Association Physician Compensation Reports for a 5-year period. Surgeons were compared with nonsurgeons and across subspecialties.

Surgeon and nonsurgeon productivity in terms of relative value units remained relatively stable over the study period; surgical:nonsurgical productivity per provider was 1.30-1.46:1.

Surgeons produce a significant amount of the total work in multi-specialty medical groups. These results may indicate that the surgical and general surgical workforce has reached a plateau with respect to clinical productivity. Predicted increases in demand for procedure-based work to care for the aging population are likely to be difficult to meet with the available workforce.

To determine if patient satisfaction with ambulatory care visits differs when medical students participate in the visit.

Randomized controlled trial.

Academic general internal medicine practice.

Outpatients randomly assigned to see an attending physician only (N = 66) or an attending physician plus medical student (N = 68).

Patient perceptions of the office visit were determined by telephone survey. Overall office visit satisfaction was higher for the "attending physician only" group (61% vs 48% excellent), although this was not statistically significant (P =.16). There was no difference between the study groups for patient ratings of their physician overall (80% vs 85% excellent; P =.44). In subsidiary analyses, patients who rated their attending physician as "excellent" rated the overall office visit significantly higher in the "attending physician only" group (74% vs 55%; P =.04). Among patients in the "attending physician plus medical student" group, 40% indicated that medical student involvement "probably" or "definitely" did not improve their care, and 30% responded that they "probably" or "definitely" did not want to see a student at subsequent office visits.

Although our sample size was small, we found no significant decrement in patient ratings of office visit satisfaction from medical student involvement in a global satisfaction survey. However, a significant number of patients expressed discontent with student involvement in the visit when asked directly. Global assessment of patient satisfaction may lack sensitivity for detection of dissatisfaction. Future research in this area should employ more sensitive measures of patient satisfaction.

The purpose of this study was to evaluate the feasibility of implementing a core curriculum in health policy and practice for radiology residents and fellows, to determine whether such a curriculum would be considered professionally valuable by participants, and to determine if the curriculum would influence participants' careers.

A core curriculum in health policy and practice was developed, involving 19 seminars presented over 5 weeks. Twelve faculty members presented comprehensive and integrated information relevant to current and future radiology practice. Topic clusters included health care structure and payment, technology and health services, radiology practice management, and career issues. Classroom teaching was supplemented by a course syllabus and resource library. Participants were surveyed following each seminar and at the conclusion of the curriculum.

Participants described their baseline knowledge of each topic as weak. As a result of the curriculum, self-described knowledge ratings increased considerably. Interest in curriculum topics and perception of their importance and relevance to radiology practice increased. Of respondents, 84% (26 of 31) described the curriculum as having very good or excellent educational value. All respondents indicated that the curriculum should be repeated in the future, 42% (13 of 31) indicated that the curriculum motivated them to pursue further related education, and 61% (19 of 31) developed interest in personal involvement in administrative issues and radiology organizations.

A core curriculum in health policy and practice was successfully integrated into radiology training. The curriculum resulted in increased knowledge, interest, and perceived importance of medical management issues by residents and fellows and stimulated their interest in pursuing further management education and involvement in radiology administration and organizations.

Managed care aims to insure the health of a population rather than that of an individual. This paper compiles opinions of psychiatrists and others on managed care and lists ways managed care potentially affects psychiatry. Managed care reverses the economic incentives indemnity insurance gave doctors to prolong treatment. It encourages psychiatrists to spend less time on empathic discussion and to use more standardized, less costly treatments. Many psychiatrists feel distressed about how managed care has changed their practices. Capitation care will change it further. Current trends suggest the U. S. will use and train fewer psychiatrists. Psychiatrists will spend less time with individual patients and more time planning and guiding the treatment of severely impaired patients. Many more psychiatrists will likely have unprecedented changes imposed on their careers.

Managed care in its numerous forms is continuing to change the face of the healthcare system in the United States. IMPACT OF MANAGED CARE ON MEDICAL EDUCATION: As managed care continues to invade the market, it has a substantial influence in shaping the parameters of graduate medical education. Various surveys have shown that residents are under-trained in managed care principles and practice. There is a clear need for a residency curriculum that fully prepares students to keep pace with modern markets. EDUCATIONAL METHODOLOGY: This manuscript describes a curriculum which emphasizes the role of the primary care physician, cost-effective practice, multidisciplinary practice and evidenced-based strategies. Educational methods and concepts presented here are based on the recommendations of healthcare educators, extensive literature searches and United States advisory panels. After the curriculum is completed, the resident will: 1. Practice cost-effectively under 100% capitation and learn proper risk management. 2. Utilize epidemiological thinking and community-oriented primary care. 3. Function as a part of healthcare team and understand how to achieve cost-effective care for patients. 4. Practice the principles of continuous quality improvement and assess patient satisfaction. 5. Practice and adopt evidence-based medicine and guidelines. 6. Become skilled with computers including facility with literature searches, databases and the internet. 7. Practice a full spectrum of primary care emphasizing patient education and psychosocial health. 8. Understand the ethical issues pertinent to managed care practices.

The residency curriculum committee will evaluate the managed care curricular elements on an on-going basis.

This comprehensive curriculum for primary care residents can help ensure success in the new healthcare marketplace.

Comprehensive information on pathology workforce is currently not available. Prudent planning for pathology Graduate Medical Education (GME) requires more timely data than presently exist. In addition, we lack understanding of workforce kinetics in academic pathology which often serves as a buffer in times of surplus. Although the heads of community hospital and private laboratory groups control the majority of decisions regarding pathology workforce, a database of these decision-makers does not exist. However, information from the most recent published sources strongly suggests that a significant surplus already exists. Furthermore, this position is supported by earlier unpublished work from the 1994-1995 Conjoint Committee on Pathology Enhancement (CCOPE) surveys.

The purpose of this study was to determine the relationship between medical student knowledge and exposure to physiatry and the student's referral patterns for musculoskeletal disorders. Surveys were mailed to senior medical students at five United States medical schools across the country with a response rate of 26% (n=191). Five common musculoskeletal and neurologic disorders were presented as clinical vignettes and the student was asked to assume the role of a primary care physician and refer the patient to one of eight specialists listed. A section to assess the student's subjective overall knowledge and exposure to these fields was also included. Physiatrists received 27% of the referrals for evaluation and treatment of chronic low-back pain, 3% of the referrals for acute low-back pain, 10% of the referrals for carpal tunnel syndrome, 22% of the referrals for an industrial medicine injury, and 20% of the referrals for a sports medicine injury. The frequency of physiatry referrals for three of the five cases was significantly correlated (P < 0.05) with the student's overall knowledge of physical medicine and rehabilitation (PM&R). The presence of a department of PM&R at the student's school, however, did not have a significant impact on the rate of referrals. The results indicate that senior medical students referral patterns are strongly influenced by knowledge of PM&R. This suggests that focusing efforts on increasing this awareness may be an effective means of increasing referrals to physiatry in the future.

The North American Society for Pediatric Gastroenterology and Nutrition (NASPGN) performed a Workforce Survey to determine the current number and distribution of pediatric gastroenterologists in the United States and Canada and to estimate the supply and demand in the future in the United States.

The response rate was more than 90%. There were 624 pediatric gastroenterologists in the United States, and 48 in Canada.

There were 2.4 pediatric gastroenterologists per million population in the United States, ranging from 3.1 per million in the Northeast to 1.9 per million in the West, and 1.6 per million in Canada. In the United States, fewer than 5 pediatric gastroenterologists retire each year, but more than 40 fellows per year complete training. In the United States, 30% of pediatric gastroenterologists believe there is already an excess supply; only 12% believe there is a shortage (p < 0.001).

If the number of fellows who complete training each year remains unchanged, in 10 years there will be more than 950 pediatric gastroenterologists in the United States (3.3 per million population). At the same time, if the demand for pediatric gastroenterologists remains 2.4 per million population, there will be a demand for only 675. If these assumptions are correct, it is necessary to reduce the number of fellows to be trained. Although it is difficult to predict future workforce needs reliably, we recommend that the number of fellowship positions in training programs in the United States be reduced by 50% to 75%. Changes in health care in the coming years will be challenging, and effective planning is necessary for pediatric gastroenterologists to achieve their clinical, research, and educational missions.

The goal of this report is to provide information regarding the number of potential academic positions available for newly trained urologists in the United States.

In August 1995 and November 1996, a 5-question survey was mailed to 115 chairs or division heads in the United States, requesting total of faculty hires anticipated during the next 5 years, prerequisite fellowship training, areas of subspecialty expertise, American Urological Association section and estimated protected time for research.

Response rate was 86% (98 programs). In 1995 there were 203 anticipated jobs, including 45 positions for oncology, 40 neurourology/female urology, 37 calculus/endourology, 26 general/urology office, 25 infertility/impotence, 23 pediatric, and 7 transplant urology. Of the positions 51% will require at least a clinical fellowship, and 83% of these individuals will be offered 10 to 25% protected time for research. By 1997 there were only 20 less predicted positions and only 11 departments anticipated less hires than 1 year earlier.

The number of near-term urology positions is encouraging for individuals interested in academic urology. Optimistic predictions probably reflect unique service, research and teaching needs for academic programs rather than merely manpower requirements based on projected managed care models. Anticipated faculty positions appear to exceed overall projections pertaining to the need for urologists based solely on patient population demographics.