Academic medicine : journal of the Association of American Medical Colleges
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The Generalist Physician Initiative (GPI) was created by The Robert Wood Johnson Foundation to help medical schools increase the number of predoctoral and residency graduates entering generalist careers. The underlying assumption of the GPI is that more medical graduates will become generalists if schools select candidates whose personal characteristics are compatible with generalist careers and if schools provide for them an educational environment that values generalist careers in the same manner it has valued specialist careers. In essence, the GPI is helping schools modify the culture in which medical education occurs so that they may increase their production of generalists. ⋯ Most schools have developed external partners (e.g., state legislatures, managed care organizations, area health education centers) to assist in achieving their goals. The project is now (1997) at its halfway mark. This article describes the conceptual bases for the program (e.g., changes in admission criteria to favor applicants oriented to generalism), identifies common approaches to intervention chosen by the participating schools (e.g., establishing longitudinal, generalist-oriented clinical experiences throughout the four years of medical school), and explores issues being faced by the schools as they implement change (e.g., difficulties in decentralizing clinical education to include community physicians as teachers and role models).
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Increasingly, external forces affect and constrain physicians' clinical decision making and consequently their practice of medicine. Physicians are expected to achieve optimal patient outcomes at the lowest possible cost, which requires that they have quick and convenient access to comprehensive clinical information from different sources. ⋯ They identify critical information-related issues affecting clinicians, provide a brief overview of computer applications in medical care, and discuss studies that indicate how medical information systems can assist physicians in the delivery of cost-effective, high-quality care. Finally they discuss how individual institutions can best reap the benefits of medical information systems.
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The most effective way to integrate philosophy into medical education uses ethical, social, and conceptual problems arising in medical practice such as those about informed consent, confidentiality, competency, resource allocation, the doctor-patient relationship, and death and dying. Medical students become better physicians by learning salient views on these matters and by developing philosophical skills and attitudes to (1) examine key assumptions; (2) broaden their perspectives and gain self-knowledge; (3) develop critical thinking skills about the kind of judgments they make, how bias affects their views, and the scope and limits of their knowledge claims; (4) generate tolerance, openness, and skepticism about dogma; and (5) cultivate empathy. Learning these skills and dispositions using moral, conceptual, and social issues facing them will enable students to recognize these issues when they arise in their medical practices and learn how to respond to them in justifiable ways. It will also strengthen the health care profession and institutions overall by fostering the openness, the questioning mind, and the critical thinking essential to the practice of good medicine.
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Literature analyses and syntheses are becoming increasingly important as a means of periodically bringing coherence to a research area, contributing new knowledge revealed by integrating single studies, and quickly informing scientists of the state of the field. As a result, there is a need for approaches that can provide replicable, reliable, and trustworthy results. Over the last decade many researchers have begun using the statistical meta-analysis approach to integrate studies. ⋯ This approach includes model development, literature retrieval, literature coding, rating references for quality, annotating high-quality references, and synthesizing only the subset of the literature found of sufficient quality to be considered. Also, the basic results of each included study are reported in the synthesis so that readers have before them all the "data points" used in the synthesis. Thus, readers can draw their own interpretations without having to re-collect the data, just as they would be able to do in any single study that presents original data as well as conclusions and discussion.
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The United States has a physician specialty imbalance, primarily a shortage of generalists (defined as family physicians, general internists, and general pediatricians) relative to other specialists. In recent years, the rising costs of health care, the expansion of managed care, and problems of access to care have accentuated the critical role that generalists must play in a cost-effective, accessible health care system. Despite numerous public and private initiatives designed to address the supply of generalist physicians, the ratio of generalists to specialists has been decreasing. ⋯ While they are in general agreement with the AAMC policy statement, they feel the recommended strategies fall short of the need. They maintain that the AAMC statement represents an admirable but cautious approach to a daunting problem, and that the time is past when cautious approaches will suffice. The authors conclude with the hope that bolder initiatives will emerge from the new AAMC Office of Generalist Physician Programs.