Journal of general internal medicine
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Review
Interactions between pharmaceutical representatives and doctors in training. A thematic review.
Medical school and residency are formative years in establishing patterns of prescribing. We aimed to review the literature regarding the extent of pharmaceutical industry contact with trainees, attitudes about these interactions, and effects on trainee prescribing behavior, with an emphasis on points of potential intervention and policy formation. ⋯ The pharmaceutical industry has a significant presence during residency training, has gained the overall acceptance of trainees, and appears to influence prescribing behavior. Training programs can benefit from policies and curricula that teach residents about industry influence and ways in which to critically evaluate information that they are given. Recommendations for local and national approaches are discussed.
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Multicenter Study
Sins of omission: getting too little medical care may be the greatest threat to patient safety.
Little is known about the relative incidence of serious errors of omission versus errors of commission. ⋯ While preventing iatrogenic injury resulting from medical errors is a critically important part of quality improvement, we found that the overwhelming majority of substantive medical errors identifiable from the medical record were related to people getting too little medical care, especially for those with chronic medical conditions.
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The impact of national efforts to limit antibiotic prescribing has not been fully evaluated. ⋯ During the study period, outpatient antibiotic prescribing for respiratory infections where antibiotics are rarely indicated has declined, while the proportion of broad-spectrum antibiotics prescribed for these diagnoses has increased significantly. This trend resulted in a 15% decline in the total proportion of outpatient visits in which antibiotics were prescribed. However, because outpatient visits increased 17% over this time period, the population burden of outpatient antibiotic prescriptions changed little.
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Randomized Controlled Trial
A randomized-controlled study of encounter cards to improve oral case presentation skills of medical students.
To determine the feasibility of oral case presentation (OCP) encounter cards as a tool for formative evaluation, to estimate the reliability and validity of the ratings when used in a medicine clerkship, and to examine whether the use of OCP encounter cards improves students' OCP skills. ⋯ OCP encounter cards are a novel and feasible tool to assess clerkship students' oral case presentation skills. OCP card ratings are reproducible, and validity is suggested by their correlation with multiple markers of performance. However, encounter cards did not improve performance on summative oral presentations.
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The reliance on physical examination as a diagnostic aid is in decline. ⋯ A skills improvement program can significantly increase the frequency of physical examination, but teaching and feedback events remain sporadic and infrequent.